CAJ | 학술논문

目的：观察奥美沙坦及氨氯地平对高血压血压晨峰（MBPS）管理和靶器官保护的疗效。方法103例原发性高血压MBPS患者随机分为两组，分别接受奥美沙坦（53例，20 mg/d）或苯磺酸氨氯地平（50例，5 mg/d），治疗6个月。于治疗前和治疗4及8周做24 h动态血压监测，两组均可剂量翻倍或添加其他类降压药物以达到血压控制。8周后两组患者血压均控制在正常范围。对比基线与6个月后超声结果[左室质量指数（LVMI）]和尿微量白蛋白（MA）的变化。结果两组患者药物期间降低和控制24 h平均血压效果无差异，MBPS的改变相似，均较治疗前有明显改善。奥美沙坦组LVMI明显降低[（118.5±25.3)比(108.3±22.8) g/m2，P=0.031]，氨氯地平组无变化[（117.6±31.2)比(112.8±26.8) g/m2，P=0.162]。两组患者MA降低显著。MBPS与LVMI和MA改变无相关性，24 h和最后2~4 h血压改变与LVMI改变密切相关。结论奥美沙坦酯能有效控制原发性高血压MBPS，逆转左室肥厚和降MA。
목적：관찰오미사탄급안록지평대고혈압혈압신봉（MBPS）관리화파기관보호적료효。방법103례원발성고혈압MBPS환자수궤분위량조，분별접수오미사탄（53례，20 mg/d）혹분광산안록지평（50례，5 mg/d），치료6개월。우치료전화치료4급8주주24 h동태혈압감측，량조균가제량번배혹첨가기타류강압약물이체도혈압공제。8주후량조환자혈압균공제재정상범위。대비기선여6개월후초성결과[좌실질량지수（LVMI）]화뇨미량백단백（MA）적변화。결과량조환자약물기간강저화공제24 h평균혈압효과무차이，MBPS적개변상사，균교치료전유명현개선。오미사탄조LVMI명현강저[（118.5±25.3)비(108.3±22.8) g/m2，P=0.031]，안록지평조무변화[（117.6±31.2)비(112.8±26.8) g/m2，P=0.162]。량조환자MA강저현저。MBPS여LVMI화MA개변무상관성，24 h화최후2~4 h혈압개변여LVMI개변밀절상관。결론오미사탄지능유효공제원발성고혈압MBPS，역전좌실비후화강MA。
Objective To investigate the effects of olmesartan and amlodipine on morning blood pressure surge(MBPS)measurement and the target organ protection in hypertension. Methods 103 primary hypertension patients with MBPS were randomly divided into the two groups and treated by olmesartan(53 cases,20 mg/d) or amlopipine besylate(50 cases,5 mg/d) for 6 months respectively. The 24 h ambulatory blood pressure monitoring was performed before treatment and at 4,8 weeks of treatment in the two groups. The doses could be doubled or other antihypertensive drugs were added in both groups for controlling the blood pressure. After 8 weeks,BP was con-trolled to normal range in the two groups( P < 0. 05). The baseline echocardiographic findings(left ventricular mass index,LVMI) and microalbuminuria(MA) were compared with those at the end of 6-month follow-up period. Results Lowering and controlling 24 h mean BP levels had no statistically significant difference between two groups. The MBPS change was similar and significantly improved compared with before treatment. LVMI in the olmesartan group was significantly decreased[(118. 5 ± 25. 3)g/m2 vs(108. 3 ± 22. 8)g/m2, P=0. 031 ] ,while the amlodipine group had no change [(117. 6 ± 31. 2)g/m2 vs(112. 8 ± 26. 8)g/m2,P=0. 162 ] . MA was significantly decreased in the two groups. The change in MBPS had no significant correlation with the change in LVMI and MA,24 h and final 2-4 h BP change was closely correlated with the LVMI change. Conclusion Olmesartan medoxomil can effectively control MBPS in primary hypertension,reverses the left ventricular hypertrophy and decreases MA.