谷峰比值和平滑指数在降压药物疗效评价中的应用

目的 :探讨谷峰比值合理计算方法 ,并比较其与平滑指数反映降压药物降压作用的稳定性。方法 :结合乐卡地平在高血压病人中的疗效研究 ,6 0例病人分别在治疗wk 0 ,6 ,8末进行 3次 2 4h动态血压检测。以不同方法计算服药后峰 /谷效应值、谷峰比值和平滑指数 ,并比较其重复性。结果 :以 2h时间段进行计算 ,峰 /谷效应值下降最少 ,重复性增加明显。以治疗有效病人为对象计算谷峰比值为正态分布 ,分布相对集中。治疗wk 6末和wk 8末相比 ,平滑指数重复性优于谷峰比值。结论 :建议在降压药疗效评价中取降压幅度最大的相邻 2h时间段计算峰效应值 ,下次服药前 2h时间段计算谷效应值 ,选择治疗有效病人计算谷峰比值 ,并增加平滑指数来更稳定地反映药物的平稳降压作用

Discussion of trough:peak ratio and smoothness index in clinical evaluation of antihypertensive agents

AIM: To discuss the calculation method of T/P ratio and compare it with smoothness index(SI), in order to know which is more stable for assessing the homogeneity of 24 h BP reduction by antihypertensive treatment. METHOD: While was studied in 60 patients with mild to moderate hypertension the efficacy of lercanidipine, each patient took part in 24 h ABPM at the end of run in period, the 6 wk and the 8 wk of treatment, respectively. Peak/trough changes, T/P ratio and smoothness index were calculated by different methods, and their reproducibility was compared. RESULTS: The best compromise between correct estimate of peak change and the reproducibility was the average of the adjacent 2 h with maximal BP fall, and that of trough change and reproducibility was average of the last 2 h of 24 h. Selecting all the patients to treatment, the T/P ratio showed large scatters, while selecting the responders to treatment reduced the dispersion. SI for SBP and DBP showed better reproducibility than T/P ratio at the end of 6 wk and 8 wk of treatment. CONCLUSION: When the T/P ratio is assessed, peak and trough change should preferably be computed over 2 h time window. We should select responders to treatment while calculating the T/P ratio. SI should also be recommended in the evaluation for it can be more stable for evaluating the homogeneity of 24h BP reduction than T/P ratio.