苯磺酸氨氯地平联合缬沙坦夜间给药对夜间高血压患者的疗效及肾功能的影响

发布时间：2018-02-09 16:29

本文关键词： 高血压血管紧张素受体拮抗药钙通道阻滞剂　出处：《中国循环杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的:探讨苯磺酸氨氯地平联合缬沙坦夜间给药对夜间高血压患者的血压和肾功能指标的影响。方法:将87例服用4周苯磺酸氨氯地平疗效不佳的夜间高血压患者随机分为对照组(43例)和观察组(44例),对照组患者在服用磺酸氨氯地平的基础上早晨给予口服缬沙坦(80~160 mg/次,1次/d),观察组患者在服用磺酸氨氯地平的基础上晚上给予口服缬沙坦(80~160 mg/次,1次/d),均连续治疗8周。通过检测24 h动态血压观察两组患者治疗前后白天和夜间血压水平及肾功能指标的变化,并观察不良反应发生情况。结果:观察组患者白天和夜间平均收缩压(SBP)、舒张压(DBP)水平均较治疗前明显降低[白天平均SBP:(132.16±9.04)mmHg vs(152.52±10.73)mmHg;白天平均DBP:(83.06±8.04)mmHg vs(98.49±8.74)mmHg;夜间平均SBP:(131.73±10.10)mmHg vs(141.12±12.27)mmHg;夜间平均DBP:(75.87±7.47)mmHg vs(85.83±8.51)mmHg],并且治疗后,观察组患者夜间SBP、DBP水平低于对照组[SBP:(115.45±9.78)mmHg vs(131.73±10.10)mmHg,DBP:(67.26±7.15)mmHg vs(75.87±7.47)mmHg],差异有统计学意义(P0.05);治疗后两组患者白天SBP和DBP无差异。治疗后观察组患者血清肾功能水平有明显改善,观察组患者血清尿素氮(BUN)、血肌酐(Cr)和尿β2-微球蛋白(β2-MG)水平均低于对照组[BUN:(4.47±0.95)mmol/L vs(5.06±1.08)mmol/L,血Cr(78.15±8.51)μmol/L vs(83.46±8.04)μmol/L,β2-MG:(2.78±0.74)mg/L vs(3.37±0.88)mg/L,P均0.05],估计肾小球滤过率(eGFR)高于对照组[(81.57±9.54)ml/(min·1.73 m~2)vs(61.18±13.34)ml/(min·1.73 m~2),P0.05];观察组患者不良反应发生率为6.82%,与对照组(4.65%)比较无明显差异(P0.05)。结论:苯磺酸氨氯地平联合缬沙坦夜间药物治疗可有效控制夜间血压水平,改善肾功能,且不增加不良反应。
[Abstract]:Objective: to investigate the effect of amlodipine besylate combined with valsartan on blood pressure and renal function in patients with nocturnal hypertension. The patients were randomly divided into control group (n = 43) and observation group (n = 44). The patients in the control group were given oral valsartan 80160 mg / d on the basis of amlodipine sulfonate in the morning. The patients in the observation group were treated with amlodipine sulfonic acid on the basis of amlodipine sulfonate later in the day. The patients were given oral valsartan 80 mg / time for 8 weeks. The changes of day and night blood pressure and renal function were observed before and after 24 h ambulatory blood pressure test. Results: the mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels in the observation group were significantly lower than those before treatment [SBP:(132.16 卤9.04 SBP:(132.16 卤10.73 mm Hg during the day; DBP:(83.06 卤8.04 mm Hg vs(98.49 卤8.74 mm Hg in the daytime; SBP:(131.73 卤10.10 mm Hg vs(141.12 卤12.27 mm Hg in the night; DBP:(75.87 卤7.47 mm Hg vs(85.83 卤8.51 mm Hg] in the observation group. The level of SBP in the observation group was lower than that in the control group [SBP:(115.45 卤9.78 vs(131.73 卤10.10 mm vs(131.73 卤10.10 mm Hg], the difference was statistically significant (P 0.05), but there was no difference between the two groups in daytime SBP and DBP after treatment. After treatment, the serum renal function of the patients in the observation group was significantly improved. The levels of serum urea nitrogen bun, creatinine creatinine (Cr) and urinary 尾 2-microglobulin (尾 2-MGR) in the observation group were lower than those in the control group [BUN:(4.47 卤0.95mmol / L vs(5.06 卤1.08mmol / L, Cr(78.15 卤8.51渭 mol/L vs(83.46 卤8.04渭 mol / L, 尾 2-MGW 2.78 卤0.74mg / L vs(3.37 卤0.88mg / L P 0.05], and the estimated filtration rate eGFRwas higher than that in the control group [81.57 卤9.54ml / min 路1.73 mmol / min 路1.73 mmol-1 / min, 61.18 卤13.34ml / min 路1.73 mml / min 路1.73 mg / L]. Conclusion: amlodipine benzenesulfonate combined with valsartan can effectively control nocturnal blood pressure. Improve renal function without increasing adverse reactions.
【作者单位】：青岛大学医学院;青岛大学附属医院心内科;
【分类号】：R544.1

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