贝那普利联合比索洛尔的降压疗效与血浆肾素水平的相关研究

目的探讨贝那普利的降压疗效与血浆肾素水平的相关性,寻找原发性高血压的血浆肾素水平的疗效筛选切点。方法选取2007年1月至2010年10月到哈励逊国际和平医院心血管内科就诊的年龄≥16岁轻中度原发性高血压患者200例,实验第一阶段按照单盲的原则全部应用贝那普利10 mg/d,3周。如果血压达标(<140/90 mm Hg)即可退出研究,如血压未达标,进入第二阶段,按照随机、双盲的原则分为两组:贝那普利组(75例)和贝那普利联合比索洛尔组(75例),检测治疗前后血压及肝肾功能、血脂、电解质、血糖和血常规。通过计算受试者工作特征曲线(ROC)下面积评估血浆肾素水平对贝那普利的降压疗效的敏感度和特异度及其筛选切点。结果双盲治疗后,与贝那普利组比较,贝那普利联合比索洛尔组血压下降明显,收缩压(130.0±13.0)mm Hg vs(125.9±9.7)mm Hg],P<0.05;舒张压(89.7±8.6)mm Hg vs(84.0±7.9)mm Hg],P<0.05。ROC曲线下面积计算血浆肾素活性(PRA)>2.69μg/(h.m in)是高肾素型高血压疗效的筛选切点,大于此切点建议应用贝那普利联合比索洛尔治疗,其预测灵敏度和和特异度分别为100%和94.8%。结论贝那普利联合比索洛尔降压的效果较贝那普利加量效果更好,PRA>2.69μg/(h.m in)是高肾素型高血压疗效的筛选切点。

The Studies on Theraputic Effects of Benazapril and Bisoprolol Combinationin in Hypertensive Patients and Plasma Renin Activity

Objective To explore the relationship between plasma renin activity（PRA） and theraputic effects of benazapril and bisoprolol combination in essential hypertensive patients finding the effect screening PRA tangent point.Methods A total of 200 patients with mild to moderate hypertension without severe organic diseases at cardiovascular clinic in Harrison International Peace Hospital from Jan.,2007 to Oct.,2010,100 males and 100 females,aged ≥16 years at an average of 48 yrs,were enrolled in the first-phase single-blind study,i.e.a 3-week treatment of benazapril 10mg QD,the patients with blood pressure meeting the standard（140/90 mm Hg） were out;the left were then randomly assigned to benazapril 10 mg QD group（75 cases）,benazapril 10 mg QD plus bisoprolol 5 mg QD group（75 cases） in double-blind,randomized study.SBP and DBP were recorded before and after the double-blind therapy.PRA was detected before single-blind study and low-PRA level hypertension patients were excluded.Results Compared with their baseline values,blood pressure reduction was more prominent in patients in benazapril and bisoprolol combinationin group,SBP：（130.0±13.0） mm Hg vs（125.9±9.7） mm Hg],P0.05.DBP：（89.7±8.6） mm Hg vs（84.0±7.9） mm Hg],P0.05.Receiver operating characteristic curve（PRA）2.69 μg/（h·min） was the best tangent point above which the effect of benazapril and bisoprolol combination was more significant in high PRA hypertensive patients.The prediction sensitivity and specificity is 100% and 94.8% respectively.Conclusion The theraputic effects of benazapril and bisoprolol combination in hypertensive patients is better than benazapril dosage increase.PRA2.69 μg/（h·min） is the best effective tangent point for high PRA hypertension.