缬沙坦氨氯地平（倍博特）对高血压病人血压昼夜节律性变化的影响

发布时间：2018-05-28 22:28

本文选题：缬沙坦氨氯地平 + 缬沙坦氢氯噻嗪复方片　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:探讨缬沙坦氨氯地平(倍博特)治疗高血压患者的有效性和安全性,并分析该药物对高血压患者血压昼夜节律性变化的影响。方法:本研究采用随机抽签法选取观察对象,从2015年12月-2016年9月在青岛大学附属医院心内科门诊以及住院治疗的高血压患者中选取符合标准的200例患者纳入研究领域,采取随机分组法将患者分为2组,每组100例。治疗组患者采用缬沙坦氨氯地平(倍博特)治疗,对照组患者采用缬沙坦氢氯噻嗪复方片(复代文)治疗。根据患者ms DBP(平均坐位舒张压)、ms SBP(平均坐位收缩压)的下降幅度及治疗有效标准评价降压疗效;根据患者的临床症状、体征、实验室生化指标评价药物安全性。根据血压变异性指征和平均血压计算患者血压昼夜规律。血压变异性指征:24h SBP(24小时平均收缩压)、24h DBP(24小时平均舒张压)、(d SBP)白天平均收缩压、d DBP(白天平均舒张压)、n SBP(夜间平均收缩压)、n DBP(夜间平均舒张压)。对患者随访4个月,记录MACE事件。结果:(1)基线资料比较:两组患者的基线资料比较,差异无统计学意义(p0.05)。患者基线资料包括性别、年龄、BMI(身体质量指数)、饮酒史、吸烟史、高血压家族史、冠心病史、病程;实验室生化指标包括TG(甘油三酯)、LDL-C(低密度脂蛋白胆固醇)、HDL-C(高密度脂蛋白胆固醇)、TC(总胆固醇)、UA(尿酸)、FPG(空腹血糖)。(2)降压疗效:两组患者治疗前ms DBP和ms SBP水平比较,差异无统计学意义(p0.05);治疗8周后,治疗组ms DBP和ms SBP下降幅度大于对照组,两组数据比较,差异有统计学意义(p0.05);(3)两组患者治疗前24h SBP、24h DBP、d SBP、d DBP、n SBP、n DBP比较,差异无统计学意义(p0.05)。治疗后第4、8周两组患者24h SBP、24h DBP、d SBP、d DBP、n SBP、n DBP与治疗前比较,均有所下降;治疗组与对照组治疗后4周的n SBP比较,差异有统计学意义(p0.05),其余数据治疗后4周比较,差异无统计学意义(p0.05);治疗后8周,治疗组的n SBP和n DBP与对照组比较,差异有统计学意义(p0.05)。(4)血压变异性比较:治疗组和对照组治疗前24h SBPV、24h DBPV、d SBPV、d DBPV、n SBPV、n DBPV水平比较,差异无统计学意义(p0.05);治疗后,两组24h SBPV、24h DBPV、d SBPV、d DBPV、n SBPV、n DBPV水平均有所下降;治疗组在治疗后的第4周,24h DBPV、d DBPV、n DBPV就已有明显降低,与对照组比较,差异有统计学意义(p0.05);治疗后第8周,两组24h SBPV、24h DBPV、d SBPV、d DBPV、n SBPV、n DBPV明显下降,且治疗组下降较对照组明显,两组比较,差异有统计学意义(p0.05)。(5)两组患者治疗后,一氧化氮水平较治疗前显著上升,而内皮素水平较治疗前明显下降,与治疗前比较,差异有统计学意义(p0.05);与对照组比较,治疗组一氧化氮水平和内皮素水平的上升/下降幅度更大,两组数据比较,差异有统计学意义(p0.05)。(6)治疗组MACE事件发生率虽然低于对照组,但两组MACE事件的发生率比较,无统计学意义(p0.05)。(7)安全性分析:两组患者治疗期间并未发生严重不良事件,两组不良反应率比较,差异无统计学意义(p0.05)。结论:(1)与缬沙坦氢氯噻嗪复方片治疗高血压比较,缬沙坦氨氯地平片治疗高血压的降压效果更理想。(2)缬沙坦氨氯地平片与缬沙坦氢氯噻嗪复方片比较,前者在降低高血压患者夜间血压水平上更突出。(3)缬沙坦氨氯地平片与缬沙坦氢氯噻嗪复方片均能降低高血压患者血压变异性,但前者能更进一步降低血压变异性,尤其是以舒张压变异性最为突出。(4)缬沙坦氨氯地平片与缬沙坦氢氯噻嗪复方片比较,前者在改善血管内皮功能方面更突出,其改善血压变异性的机制可能是通过改善血管内皮功能实现。(5)缬沙坦氨氯地平片在降低高血压患者心血管事件方面无显著疗效。(6)缬沙坦氢氯噻嗪复方片和缬沙坦氨氯地平片治疗高血压的不良反应低,患者均可耐受。
[Abstract]:Objective: To investigate the efficacy and safety of valsartan amlodipine (Abbott) in the treatment of hypertensive patients, and to analyze the effect of the drug on the circadian rhythm of blood pressure in patients with hypertension. Methods: This study selected the object of observation by random drawing, and was in the Department of Cardiology, Affiliated Hospital of Qiingdao University, December 2015, and lived in the Department of Cardiology, -2016 year, December 2015. Among the patients with high blood pressure in the hospital, 200 patients were selected in accordance with the standard. The patients were divided into 2 groups by random grouping method, 100 cases in each group. The patients in the treatment group were treated with valsartan amlodipine (plibot), and the patients in the control group were treated with Valsartan hydrochlorothiazide tablets (complex). According to the patient's MS DBP (average sitting position) Zhang Ya), the decrease of MS SBP (average sitting systolic pressure) and the effective standard of treatment to evaluate the effect of hypotension; evaluate the drug safety according to the patient's clinical symptoms, signs and laboratory biochemical indexes. According to the blood pressure variability index and mean blood pressure, the circadian rhythm of blood pressure is calculated. The blood pressure variability indication: 24h SBP (24 hour mean systolic pressure), 2 4h DBP (24 hour mean diastolic pressure), (D SBP) average daytime systolic pressure, D DBP (daytime diastolic pressure), n SBP (mean night systolic pressure), n DBP (mean night diastolic pressure). The patients were followed up for 4 months, and MACE events were recorded. Results: (1) baseline data comparison: the baseline data of the two groups were not statistically significant (P0.05). Materials include sex, age, BMI (body mass index), history of drinking, history of smoking, family history of hypertension, history of coronary heart disease, course of disease, laboratory biochemical indexes including TG (triglyceride), LDL-C (low density lipoprotein cholesterol), HDL-C (high density lipoprotein cholesterol), TC (total cholesterol), UA (uric acid), FPG (fasting blood glucose). (2) the curative effect of two groups of patients. There was no significant difference in the level of MS DBP and MS SBP before treatment (P0.05). After 8 weeks of treatment, the decrease of MS DBP and MS SBP in the treatment group was greater than that of the control group. The difference between the two groups was statistically significant (P0.05). (3) there was no statistically significant difference between the two groups before treatment. The difference was not statistically significant. Fourth, after treatment, 8 weeks of two groups, 24h SBP, 24h DBP, D SBP, D DBP, n SBP, n DBP were lower than before treatment. The difference was statistically significant between the treatment group and the control group at 4 weeks after treatment, and the difference was not statistically significant after 4 weeks of treatment. The difference between the treatment group and the control group after the treatment was compared with the control group at 8 weeks after treatment. (P0.05). (4) comparison of blood pressure variability: 24h SBPV, 24h DBPV, D SBPV, D DBPV, n SBPV before treatment in the treatment group and the control group. PV, n DBPV had been significantly reduced, and compared with the control group, the difference was statistically significant (P0.05). Eighth weeks after treatment, the two groups of 24h SBPV, 24h DBPV, D SBPV, D DBPV were significantly decreased, and the treatment group decreased significantly compared with the control group. (5) the level of nitric oxide was compared with the treatment of the two groups. Before the treatment, the level of endothelin was significantly lower than that before the treatment, and the difference was statistically significant (P0.05). Compared with the control group, the level of nitric oxide and endothelin in the treatment group increased significantly, and the difference between the two groups was statistically significant (P0.05). (6) the incidence of MACE events in the treatment group was lower than that in the treatment group. The control group, but the incidence of the two groups of MACE events was not statistically significant (P0.05). (7) safety analysis: the two groups of patients did not have serious adverse events during the treatment, there was no significant difference in the rate of adverse reaction between the two groups (P0.05). (1) compared with the Valsartan hydrochlorothiazide compound tablets for hypertension, Valsartan and Amlodipine Tablets Treatment of hypertension is more effective. (2) compared to Valsartan and Amlodipine Tablets and valsartan hydrochlorothiazide, the former is more prominent in reducing the night blood pressure in patients with hypertension. (3) both Valsartan and Amlodipine Tablets and valsartan hydrochlorothiazide can reduce the blood pressure variability in patients with high blood pressure, but the former can be further reduced. Hypotension variability, especially with diastolic pressure variability, (4) compared to Valsartan and Amlodipine Tablets and valsartan hydrochlorothiazide, the former is more prominent in improving vascular endothelial function, and the mechanism for improving blood pressure variability may be achieved by improving vascular endothelial function. (5) Valsartan and Amlodipine Tablets is reducing high blood pressure. There was no significant effect on cardiovascular events in patients. (6) the side effects of valsartan hydrochlorothiazide tablets and Valsartan and Amlodipine Tablets were low in the treatment of hypertension, and patients were well tolerated.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

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