CAJ | 학술논문

目的：探讨不同时间服用氯沙坦治疗原发性高血压病晨峰现象的疗效及安全性。方法选取2011年2月—2013年8月滨海康达医院收治的具有晨峰现象的轻中度原发性高血压病患者186例，采用随机数字表法分为3组，晨服组62例，每日8：00左右服用氯沙坦50 mg；晚服组64例，每日20：00左右服用氯沙坦50 mg；对照组60例，给予除血管紧张素受体阻断药（ARB）与血管紧张素转化酶抑制剂（ACEI）以外的降压药物治疗，比较3组患者治疗前后平均收缩压（MSBP）、平均舒张压（MDBP）、最高收缩压（MAXSBP）及最高舒张压（MAXDBP）的变化，晨峰现象缓解率及不良反应发生率。结果治疗前，3组患者 MSBP、MDBP、MAXSBP、MAXDBP 比较，差异均无统计学意义（P ﹥0.05）。治疗后，3组患者 MSBP、MAXSBP、MAXDBP 比较，差异均有统计学意义（ P ﹤0.05）；其中晨服组、晚服组患者 MSBP 低于对照组，晚服组患者 MAXSBP 和 MAXDBP 低于对照组，晚服组患者 MSBP 低于晨服组（P﹤0.05）。晨服组患者晨峰现象缓解率为32.3％（20/62），晚服组为76.6％（49/64），对照组为26.7％（16/60），3组比较差异有统计学意义（χ2＝37.839，P ﹤0.001），其中晚服组患者晨峰现象缓解率高于晨服组和对照组（χ2＝24.952、30.911，P ﹤0.001）。晨服组患者不良反应发生率为53.2％（33/62），晚服组为53.1％（34/64），对照组为70.0％（42/60），3组比较差异无统计学意义（χ2＝4.743，P ＝0.093）。结论晚上服用氯沙坦更能有效地控制原发性高血压病晨峰现象，并不增加不良反应的发生，为更合理的治疗方案。
목적：탐토불동시간복용록사탄치료원발성고혈압병신봉현상적료효급안전성。방법선취2011년2월—2013년8월빈해강체의원수치적구유신봉현상적경중도원발성고혈압병환자186례，채용수궤수자표법분위3조，신복조62례，매일8：00좌우복용록사탄50 mg；만복조64례，매일20：00좌우복용록사탄50 mg；대조조60례，급여제혈관긴장소수체조단약（ARB）여혈관긴장소전화매억제제（ACEI）이외적강압약물치료，비교3조환자치료전후평균수축압（MSBP）、평균서장압（MDBP）、최고수축압（MAXSBP）급최고서장압（MAXDBP）적변화，신봉현상완해솔급불량반응발생솔。결과치료전，3조환자 MSBP、MDBP、MAXSBP、MAXDBP 비교，차이균무통계학의의（P ﹥0.05）。치료후，3조환자 MSBP、MAXSBP、MAXDBP 비교，차이균유통계학의의（ P ﹤0.05）；기중신복조、만복조환자 MSBP 저우대조조，만복조환자 MAXSBP 화 MAXDBP 저우대조조，만복조환자 MSBP 저우신복조（P﹤0.05）。신복조환자신봉현상완해솔위32.3％（20/62），만복조위76.6％（49/64），대조조위26.7％（16/60），3조비교차이유통계학의의（χ2＝37.839，P ﹤0.001），기중만복조환자신봉현상완해솔고우신복조화대조조（χ2＝24.952、30.911，P ﹤0.001）。신복조환자불량반응발생솔위53.2％（33/62），만복조위53.1％（34/64），대조조위70.0％（42/60），3조비교차이무통계학의의（χ2＝4.743，P ＝0.093）。결론만상복용록사탄경능유효지공제원발성고혈압병신봉현상，병불증가불량반응적발생，위경합리적치료방안。
Objective To investigate the efficacy and safety of losartan at different time points in the treatment of morning blood pressure surge(MBPS)in patients with primary hypertension. Methods We enrolled 186 patients with light and moderate primary hypertension and MBPS who were admitted into Binhaikangda Hospital from February 2011 to August 2013. Using random number table method,we divided the patients into three groups. We assigned 62 patients into morning group in which 50 mg losartan was administrated at 8:00,assigned 64 patients into evening group in which 50 mg losartan was administrated at 20:00 and assigned 60 patients into control group in which hypotensive drugs apart from ARB and ACEI were administrated. Comparison was made among the three groups in the changes of MSBP,MDBP,MAXSBP and MAXDBP after treatment,the rate of MBPS alleviation and the incidence rate of adverse reaction. Results Before treatment,the three groups were not significantly different(P ﹥ 0. 05)in MSBP,MDBP,MAXSBP and MAXDBP. After treatment,the three groups were significantly different(P ﹤ 0. 05)in MSBP,MAXSBP and MAXDBP;morning group and evening group were lower(P ﹤ 0. 05) than control group in MSBP,evening group was lower(P ﹤ 0. 05)than control group in MAXSBP and MAXDBP,and evening group was lower(P ﹤ 0. 05)than morning group in MSBP. The rates of MBPS alleviation of morning group,evening group and control group were 32. 3% (20 / 62),76. 6% (49 / 64)and 26. 7% (16 / 60) respectively,with no significant differences among the three groups(χ2 = 37. 839,P ﹤ 0. 001);the evening group was higher than morning group and control group in the rate of MBPS alleviation(χ2 = 24. 952,30. 911,P ﹤ 0. 001). The rates of adverse reaction of morning group,evening group and control group were 53. 2% (33 / 62),53. 1% (34 / 64)and 70. 0% (42 / 60)respectively,with no significant differences among the three groups(χ2 = 4. 743,P = 0. 093). Conclusion The evening administration of losartan can effectively control MBPS in patients with primary hypertension without increase in adverse reaction,thus the evening administration is more rational.