短效联合长效降压药物在有晨峰现象及杓型曲线高血压病患者中的应用

目的通过24h动态血压（ABPM）监测,探讨短效联合长效降压药物对有晨峰现象及杓型曲线高血压病患者的作用,并以平滑指数（SI）评价药物的疗效。方法选择在我院住院的符合1999年WHO/ISH制定的高血压诊断标准的高血压病患者90例,经ABPM 24h检测血压节律呈杓型及超杓型。随机分为A组30例,予洛汀新片剂10mg口服,6∶00及18∶00各服1次;B组30例,予倍它乐克片剂25mg晨醒时口服及洛汀新片剂10mg11∶00口服;C组30例,予卡托普利片剂25mg晨醒时口服及洛汀新片剂10mg11∶00口服。治疗2周后复查ABPM,得出24h平均血压、清晨平均血压、夜间最低血压、清晨-睡眠血压差、血压SI。结果治疗前3组24h平均血压、清晨血压、清晨-睡眠血压差差异均无统计学意义（均P〉0.05）。治疗2周后B、C两组与A组比较,24h平均血压、清晨平均血压及清晨-睡眠血压差均显著降低（P〈0.01）;C组与B组比较,24h平均收缩压、清晨平均血压均显著降低（均P〈0.05）。收缩压SIC组高于A组（P〈0.01）;而B组与A组比较,差异无统计学意义（P〉0.05）;舒张压SI3组差异均无统计学意义（均P〉0.05）。结论晨醒时服短效降压药物（如卡托普利、倍它乐克）联合长效降压药物（如洛汀新）控制血压既能达到长效药物持续平稳的降压效果,又能更好的控制清晨高血压、24h平均血压,减小清晨-睡眠血压差。

Combination of short-effect and long-effect antihypertensive drugs in treatment of patients with morning surge and spoon type hypertension

Objective To evaluate the efficacy of combination therapy with short-effect and long-effect antihypertensive drugs in treatment of patients with morning surge and spoon type hypertension.Methods Ninety patients with spoon type or super-spoon type hypertension,or morning surge were enrolled in the study.Blood pressure was recorded by 24h ambulatory blood pressure monitoring(ABPM)and the hypertension was diagnosed according to the criteria formulated by the WHO/ISH in 1999.All patients were randomized to group A(Lotensin 10mg administered at 6 a.m.and 6 p.m.)or group B(Betaloc 25 mg administered in the morning waking up and Lotensin administered at 11 a.m.)or group C(Captopril 25 mg administered in the morning waking up and Lotensin administered at 11 a.m.).Two weeks before and after treatment parameters were determined,including 24h MBP,morning MBP,the lowest value of blood pressure during a night,change value of blood pressure in sleeping in the morning,smoothness index(SBP and DBP was included in this parameter).Results 24h MBP,morning MBP and change value of blood pressure in sleeping in the morning were significantly reduced(B C versus A,P<0.01).24h MBP and morning MBP were decreased markedly(B versus C,P<0.05).The systolic pressure SI was higher in group C than that in group A(P<0.01),and no significant difference was detected among group B and group A.There was no significant difference of diastolic pressure SI in three groups.Conclusion The combination with short-effect and long-effect antihypertensive drugs is effective in treatment of patients with spoon type hypertension or morning surge,by which the BP can be decteased stably and the 24h MBP,morning MBP and change value of blood pressure in sleeping in the morning were also controlled satisfactorily.