CAJ | 학술논문

目的：探讨小剂量左氨氯地平、替米沙坦及氢氯噻嗪同时或不同时给药降压及逆转非杓型血压的效果。方法选择300例收缩压（SBP）＜180mmHg，舒张压（DBP）91～109mmHg，年龄＞45岁的非杓型高血压患者，随机分为两组，Ⅰ组（不同时给药组）晨服替米沙坦40mg和氢氯噻嗪10mg，晚服左氨氯地平2.5mg；Ⅱ组（同时给药组）以上3种药物均晨服，所有病例治疗前及治疗8周后进行动态血压监测。结果（1）治疗8周后，Ⅰ组和Ⅱ组的24h SBP/DBP分别降低14.92/9.96和15.04/10.66mmHg，日间SBP/DBP分别降低13.90/10.60和16.06/11.70mmHg，均较治疗前明显降低（P＜0.01）；两组24h和日间SBP/DBP治疗后差异无统计学意义（P＞0.05）。（2）Ⅰ组夜间SBP/DBP降低25.44/19.48mmHg，与治疗前相比差异非常显著（P＜0.01）。（3）Ⅱ组夜间SBP/DBP降低17.68/14.76mmHg，与治疗前差异也有统计学意义（P＜0.05）。（4）治疗后夜间SBP/DBP降幅Ⅰ组较Ⅱ组差异更明显（P＜0.01）。（5）Ⅰ组逆转率为88.16%，Ⅱ组为55.41%，两组比较差异有统计学意义（P＜0.01）。结论小剂量左氨氯地平、替米沙坦及氢氯噻嗪两种服药方法均能有效地控制24h血压和日间血压，而不同时给药能更好地逆转非杓型高血压。
목적：탐토소제량좌안록지평、체미사탄급경록새진동시혹불동시급약강압급역전비표형혈압적효과。방법선택300례수축압（SBP）＜180mmHg，서장압（DBP）91～109mmHg，년령＞45세적비표형고혈압환자，수궤분위량조，Ⅰ조（불동시급약조）신복체미사탄40mg화경록새진10mg，만복좌안록지평2.5mg；Ⅱ조（동시급약조）이상3충약물균신복，소유병례치료전급치료8주후진행동태혈압감측。결과（1）치료8주후，Ⅰ조화Ⅱ조적24h SBP/DBP분별강저14.92/9.96화15.04/10.66mmHg，일간SBP/DBP분별강저13.90/10.60화16.06/11.70mmHg，균교치료전명현강저（P＜0.01）；량조24h화일간SBP/DBP치료후차이무통계학의의（P＞0.05）。（2）Ⅰ조야간SBP/DBP강저25.44/19.48mmHg，여치료전상비차이비상현저（P＜0.01）。（3）Ⅱ조야간SBP/DBP강저17.68/14.76mmHg，여치료전차이야유통계학의의（P＜0.05）。（4）치료후야간SBP/DBP강폭Ⅰ조교Ⅱ조차이경명현（P＜0.01）。（5）Ⅰ조역전솔위88.16%，Ⅱ조위55.41%，량조비교차이유통계학의의（P＜0.01）。결론소제량좌안록지평、체미사탄급경록새진량충복약방법균능유효지공제24h혈압화일간혈압，이불동시급약능경호지역전비표형고혈압。
ObjectiveTodetermine the efficacy of small doses oflevamlodipine,telmisartan andhydrochlorothiazide given at the sameor differenttimepointson anti-hypertension and reverse of non dipper hypertension.Methods Three hundredover-45-year-old patientswith non-dipper hypertension [systolic blood pressure (SBP)<180mmHg and diastolic blood pressure (DBP) ranging from 90 to 109mmHg)] admitted in our out- and in-patient departments from May 2011 to October 2013 were prospectively subjected in this study. They were randomly divided into 2 groups, groupⅠ (the drugswere given at different time, 40mg telmisartan and 10mg hydrochlorothiazide weregiven in the morning, while 2.5mg levamlodipine at night), and groupⅡ (all 3 drugs were given at the morning). All cases receivedambulatory blood pressure monitoring beforeand in 8 weeks after treatment.Results In 8 weeks after the treatment, the 24-hourSBP/DBP was reduced by 14.92/9.96mmHg and 15.04/10.66mmHg respectively for groupsⅠ andⅡ, while the daytimeSBP/DBP was decreased by 13.90/10.60mmHg and 16.06/11.70mmHg,respectively. Theseindices were all significantly lower thanbefore treatment (P<0.01), but there was no difference between the 2 groups (P>0.05). The nighttimeSBP/DBP was reduced by 25.44/19.48mmHg in groupⅠ and by 17.68/14.76mmHg in groupⅡ, and bothwere significantly lower than beforetreatment (P<0.01,P<0.05). The reversion of non-dipper hypertension was 88.16% and 55.41% for the 2 groups, with significant difference between them (P<0.01).Conclusion No matter small doses of levamlodipine,telmisartan andhydrochlorothiazideare givenat the sameor differenttimepoints,theyeffectively control the 24-hour and daytime blood pressures. But the drugs given at different time pointscan reverse non-dipper hypertension better.