氯沙坦与缬沙坦治疗原发性高血压的疗效比较

目的比较2种血管紧张素Ⅱ受体拮抗剂(ARB)类降压药——氯沙坦和缬沙坦的降压效果。方法将213例原发性高血压(EH)患者随机分为A组108例和B组105例。A组给予氯沙坦治疗,B组给予缬沙坦治疗,疗程均为8周。观察2组临床疗效、降压幅度、血液生化指标及不良反应。结果 A组降压显效率为84.26%高于B组的70.48%,差异有统计学意义(P<0.05)。治疗后,2组收缩压(SBP)、舒张压(DBP)水平均明显降低,且A组降压幅度大于B组,差异有统计学意义(P<0.05或P<0.01)。治疗前后2组血液生化指标均无明显变化。A组不良反应发生率为3.70%低于B组的22.86%,差异有统计学意义(P<0.01)。结论与缬沙坦相比,氯沙坦治疗EH疗效更好,不良反应发生率更低,值得临床推广应用。     

缬沙坦治疗原发性高血压及左室肥厚疗效观察

目的 探讨缬沙坦治疗原发性高血压（EH）及左室肥厚（LVH）的临床疗效。方法 78例病人口服缬沙坦80mg,每天1次,疗程4周。用动态血压仪记录EH病人的降压效果;用超声心动图测量LVH病人的左室肥厚改善情况。结果 缬沙坦可使血压24h平稳下降,且左室质量指数较治疗前减低（P＜0．01）。结论 缬沙坦不仅具有良好的降压效果,而且对EH病人的LVH也有较好的逆转作用。     

非洛地平与缬沙坦联合用于原发性高血压患者的疗效观察

高血压是以体循环动脉压增高为主要表现的临床综合征,是最常见的心血管疾病,机体血压升高是多种病理生理机制参与的结果,使用一种降压药往往效果不理想.目前倾向于主张不同降压机制的药物联合使用,以获得满意的效果.本旨在研究二氢吡啶类钙通道阻滞剂非洛地平与血管紧张素Ⅱ受体拮抗剂缬沙坦合用的降压疗效,并观察其不良反应.     

氯沙坦治疗老年原发性高血压的效果分析

目的：观察血管紧张素Ⅱ（AⅡ）受体拮抗剂氯沙坦对老年患者的降压效果及耐受性。方法：60例患者每天服用氯沙坦钾（科素亚）片50mg,疗程4－8周,服药前后监测24h动态血压以评价降压疗效,并观察治疗过程中出现的副作用及肝、肾功能变化等,判断其耐受性,结果：全部患者24h收缩压和舒张压均明显下降（P＜0．01）,收缩压谷峰比为72％,舒张压谷峰比为565,对夜间血压不产生过度降压作用,未见首剂或体位性低血压,且对糖、脂代谢及电解质等无不良影响,副反应发生率较低。结论：每日50mg氯沙坦对老年原发性高血压患者有24h平衡降压作用及良好的耐受性。     

不同剂量的缬沙坦治疗肾性高血压的疗效观察

目的 观察不同剂量的缬沙坦治疗慢性肾小球肾炎肾性高血压的临床疗效和安全性.方法 30例肾性高血压患者随机分为缬沙坦80mg组和缬沙坦160mg组,治疗12周,观察两组患者治疗前后血压、24h尿蛋白定量、肝肾功能、血脂的变化和不良反应.结果 治疗后两组患者的血压、24h尿蛋白定量水平均有显著性下降（P＜0.05）,而血肌酐、血钾、肝功能无显著变化（P＞0.05）;与80mg缬沙坦治疗组比较,160mg组患者治疗后血压及24小时尿蛋白定量显著下降（P＜0.05）.结论 两组剂量缬沙坦治疗慢性肾炎肾性高血压均有效,增加使用剂量至160mg能够增加降压速度和降低尿蛋白效果,并具有更优越的肾脏保护作用.     

小剂量联合应用缬沙坦和依那普利治疗原发性高血压160例疗效观察

原发性高血压是以血压升高为主要临床表观的综合征。原发性高血压可选择的降压药很多,其中血管紧张素转换酶抑制剂（ACEI）和血管紧张素Ⅱ受体拮抗剂（ARB）效疗较好。我们从2004年1月～2008年12月小剂量联合应用缬沙坦和依那普利治疗原发性高血压患者160例,取得了较好的疗效,而且不良反应较少,现报道如下：     

缬沙坦治疗原发性高血压的疗效观察

目的观察缬沙坦对原发性高血压(EH)的疗效。方法收集80例轻、中度原发性高血压患者,随机分为试验组和对照组,每组各60例。试验组口服缬沙坦,对照组口服卡托普利,对两组治疗4周及8周后的临床疗效和副作用进行对照比较。结果每组治疗后的有效率及血压降幅均有显著意义(P<0.05),试验组的显效率及血压降幅更明显(P<0.05)。结论缬沙坦与卡托普利均能有效降低血压,但缬沙坦疗效更显著,副作用小。     

缬沙坦逆转高血压患者左心室肥厚的临床观察

目的：观察血管紧张素Ⅱ受体拮抗剂－缬沙坦（代）的降压效果及其对高血压病合并左室肥厚的影响。方法：对32例轻，中度高血压病左心室肥厚患进行6mon的缬沙坦治疗，通过治疗前后对血压，超声多普勒心动图检测的对比，探讨缬沙坦对逆转左室肥厚的作用。结果：经过6mon的治疗，血压从162／102mmHg降至135／84mmHg(P＜0．01），左室心肌重量指数（LVMI）也明显下降（P＜0．01）。结论：缬沙坦长期治疗可使高血压患左室肥厚逆转。     

氯沙坦治疗43例老年高血压疗效观察

临床应用的抗高血压药物种类繁多，血管紧张素Ⅱ受体拮抗剂是较新一类药物，2002年我们应用氯沙坦治疗老年高血压伴左室肥厚患者43例，取得较好疗效，报告如下。     

Single-pill combination of amlodipine and valsartan in the management of hypertension

Combination therapy is increasingly recommended for selected patients with hypertension to facilitate prompt attainment and maintenance of goal blood pressure (BP). Single-pill combination therapy simplifies treatment and optimizes long-term compliance. Amlodipine, a dihydropyridine calcium antagonist, and valsartan, an angiotensin receptor blocker, are well-established antihypertensive agents with complementary mechanisms of action. This combination lowers BP significantly more than either of its components, and valsartan reduces the incidence of dose-related amlodipine-induced edema. Rigorous clinical trial data have proven the BP-lowering efficacy and high tolerability of the amlodipine/valsartan combination in patients with moderate to severe hypertension as well as other difficult-to-treat populations. Amlodipine/valsartan is indicated as initial therapy in patients who are unlikely to be controlled with a single drug and as second-line therapy in patients not responding adequately to monotherapy.     

Comparison between the antiproteinuric effects of the calcium channel blockers benidipine and cilnidipine in combination with angiotensin receptor blockers in hypertensive patients with chronic kidney disease

Aims: Benidipine, an L-/T-type calcium channel blocker, dilates renal efferent and afferent arterioles and reduces glomerular pressure; therefore, it may exert renoprotective effects. We conducted an open-labeled randomized trial to compare the effects of benidipine with cilnidipine in hypertensive patients with chronic kidney disease (CKD).

Methods: The patients who were already being treated with angiotensin receptor blockers (ARBs) received one of the following treatment regimens: benidipine at a dose of 2 mg/day that was increased up to a dose of 8 mg/day (benidipine group; n = 118) or cilnidipine at a dose of 5 mg/day that was increased up to a dose of 20 mg/day (cilnidipine group; n = 115).

Results: After 12 months of treatment, we observed a significant and comparable reduction in the systolic and diastolic blood pressure in both groups. The urinary protein:creatinine ratio was significantly decreased in both groups after 3 months of treatment and thereafter; however, the difference between both groups was not significant after 12 months of treatment. Benidipine exerted an antiproteinuric effect to a greater extent than cilnidipine in patients with diabetes.

Conclusion: The addition of benidipine as well as cilnidipine reduces urinary protein excretion in hypertensive patients with CKD who are already being administered ARBs.     

尼群地平缓释片治疗高血压病的降压效果

目的:观察尼群地平缓释片(商品名落普思,lowpresser)治疗高血压病的临床降压效果。方法:225例门诊高血压病人入选,并随机分为尼群地平组(114例)和氨氯地平组(111例)。前者口服尼群地平缓释片10mg,2次/d;后者晨服氨氯地平片5mg,总观察时间为30d。观察期间定期测定血压,并于观察开始前与服药第30天测定血钠、钾、氯和肝、肾功能。结果:服药第14、第30天两观察组血压均较观察前显著降低(P<0.01)。到第30天.尼群地平缓释片组与氨氯地平组降压总有效率分别达到84.4%与84.7%。与观察开始前比较,第30天血钠、钾、氯和肝、肾功能无明显改变。尼群地平缓释片组与氨氯地平组分别有4例和3例病人因头痛终止试验。结论:尼群地平缓释片有良好的降压效果,不良反应轻而少,服用安全。     

基于Markov模型对2种治疗高血压联合用药方案的药物经济学评价

目的 通过建立Markov模型,对血管紧张素受体拮抗剂（angiotensin receptor blockage,ARB）联合二氢吡啶类钙通道阻滞剂（calcium channel blockers,CCB）、ARB联合噻嗪类利尿剂2种治疗高血压方案进行药物经济学评价,为临床用药提供循证依据。方法 检索Medline及PubMed英文数据库,以“hypertension、calcium channel blockers、diuretics、angiotensin II receptor blocker、randomized controlled trial”及其对应的MeSH词为关键词进行检索。参考药品价格、治疗成本、健康效用值、状态转移概率建立Markov模型,对2种方案的有效性和经济学进行评价,并进行敏感性分析。结果 ARB+CCB组治疗高血压累计成本为32 780.34元,获得6.73质量调整生命年（quality-adjusted life years,QALYs）;ARB+利尿剂组治疗高血压累计成本为31 781.07元,获得6.81QALYs,相比于ARB+CCB组的增量成本效果比为-12 490.88元/QALYs。敏感性分析与原结果一致。结论 与ARB+CCB组相比,ARB+利尿剂组能获得更长的生存结果,其付出的增量成本–效果低于1倍人均GDP,更具有经济学效益。     

养血清脑颗粒联合缬沙坦氢氯噻嗪治疗老年原发性高血压的临床研究

目的 探讨养血清脑颗粒联合缬沙坦氢氯噻嗪片治疗老年原发性高血压的临床疗效。方法 选取2020年6月—2021年11月在保定市第一医院收治的82例老年原发性高血压患者为观察对象,根据随机数字表法将所有患者分为对照组和治疗组,每组各41例。对照组口服缬沙坦氢氯噻嗪片,1片/次,1次/d;治疗组在对照组治疗的基础上温水冲服养血清脑颗粒,1袋/次,3次/d。两组患者连续治疗3个月。观察两组的临床疗效,比较两组的血压指标、血流动力学指标、血清指标。结果 治疗后,治疗组患者的总有效率为95.12%,对照组的总有效率为80.49%,组间比较差异有统计学意义（P＜0.05）。治疗后,两组的24 h收缩压（24 h SBP）、24 h舒张压（24 h DBP）、24 h收缩压标准差（24 h SSD）、24 h舒张压标准差（24 h DSD）明显低于治疗前（P＜0.05）,且治疗组24 h SBP、24 h DBP、24 h SSD、24 h DSD低于对照组（P＜0.05）。治疗后,两组的体循环阻力（SVR）低于治疗前,心排血量（CO）、心脏指数（CI）高于治疗前（P＜0.05）;并且治疗组的SVR低于对照组,CO、CI高于对照组,差异有统计学意义（P＜0.05）。治疗后,两组的血清同型半胱氨酸（Hcy）、内皮素-1（ET-1）水平低于治疗前,一氧化氮（NO）水平高于治疗前（P＜0.05）;治疗组的Hcy、ET-1水平低于对照组,NO水平高于对照组（P＜0.05）。结论 养血清脑颗粒联合缬沙坦氢氯噻嗪片治疗老年原发性高血压的疗效确切,能有效控制血压,改善血流动力学指标和血管内皮功能,安全性良好。     

心可舒片联合缬沙坦治疗原发性高血压的临床研究

目的探究心可舒片联合缬沙坦胶囊治疗原发性高血压的临床疗效。方法选择2016年5月—2018年6月南通市第一人民医院收治的158例原发性高血压患者,全部原发性高血压患者分为对照组和治疗组,每组各79例。对照组口服缬沙坦胶囊,80mg/次,1次/d。治疗组在对照组基础上口服心可舒片,1.24g/次,3次/d。两组均连续治疗12周。观察两组的临床疗效,比较两组的血压、血脂水平、血清因子水平。结果治疗后,对照组和治疗组的总有效率分别为86.08%、96.20%,两组比较差异有统计学意义(P0.05)。治疗后,两组24 h平均收缩压(24 h mSBP)、24 h平均舒张压(24 h mDBP)均较治疗前显著下降,同组治疗前后比较差异有统计学意义(P0.05);且治疗组24 h mSBP、24 h mDBP明显低于对照组,两组比较差异有统计学意义(P0.05)。治疗后,治疗组总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平均显著降低,治疗前后比较差异有统计学意义(P0.05);且治疗组TC、TG、LDL-C水平均明显低于对照组,两组比较差异有统计学意义(P0.05)。治疗后,两组单核细胞趋化蛋白-1(MCP-1)、内皮素-1(ET-1)水平均显著下降,一氧化氮(NO)水平显著上升,同组治疗前后比较差异有统计学意义(P0.05);且治疗后治疗组MCP-1、ET-1、NO水平均明显优于对照组,两组比较差异有统计学意义(P0.05)。结论心可舒片联合缬沙坦胶囊治疗原发性高血压具有较好的临床疗效,能改善患者的血压血脂水平,降低炎症反应,促进血管内皮功能的恢复,具有一定的临床推广应用价值。     

硝苯地平联合倍他乐克对原发性高血压患者的疗效观察

目的 探析硝苯地平控释片联合倍他乐克治疗原发性高血压的临床疗效。方法 将100例渭南市妇幼保健院住院部收治的原发性高血压患者按随机频数表均分为观察组和对照组各50例,观察组以硝苯地平控释片和倍他乐克治疗,对照组只以硝苯地平控释片处理,治疗前后均对两组患者的24 h动态血压、心率及不良反应详细记录,连续治疗8周后,对比各项指标的变化分析治疗效果及安全性。结果 治疗后两组患者24 h收缩压、舒张压和心率均明显下降,与治疗前比较差异显著（P<0.05）。治疗后,观察组24 h收缩压、舒张压和心率均明显低于对照组,差异显著（P<0.05）。观察组收缩压和舒张压的谷峰比均明显高于对照组,差异显著（P<0.05）,表明观察组血压控制更平稳。连续治疗8周后,观察组总有效率为96.0%,对照组总有效率为78.0%,两组比较差异有统计学意义（P<0.05）。观察组不良反应率8%明显低于对照组的22%,两组比较差异有统计学意义（P<0.05）。结论 硝苯地平控释片联合倍他乐克治疗原发性高血压不仅有效,而且大大降低了药物的副作用,是临床的合理选择。     

Targeting angiotensin II type I receptors to reduce the risk of stroke in patients with hypertension

The incidence of stroke is rising among the elderly population. Hypertension is the single most important contributor to stroke, and hypertension treatment and control is the most important intervention to prevent it. Blood pressure reduction by any means will substantially reduce the risk of stroke. However, accumulating evidence indicates that angiotensin receptor blocker-based regimens may provide additional benefits in the prevention of stroke. This effect seems to be particularly prominent in high-risk patients and patients with isolated systolic hypertension. The pathophysiological mechanisms have not been clearly delineated, but favourable remodelling of the left atrium and reduction of the risk of atrial fibrillation has been suggested. In addition, blockade of the central AT1 receptors and stimulation of AT2 receptors and/or preferential reduction of central pressure by angiotensin receptor blockers may account for the beneficial protective effect.     

Telmisartan/hydrochlorothiazide combination therapy in the treatment of essential hypertension

Telmisartan is an angiotensin-II receptor blocker that has demonstrated efficacy in the reduction of blood pressure in patients with hypertension. Patients with hypertension commonly require two or more antihypertensives to reduce their blood pressure to safe levels, and the choice of combination therapy should be informed by clinical trial data. Telmisartan is available in fixed-dose combination with hydrochlorothiazide (telmisartan/HCTZ) in doses of 40 mg/12.5 mg and 80 mg/12.5 mg. Telmisartan/HCTZ has been studied in a number of clinical trials in essential hypertension, for the most part using ambulatory blood pressure monitoring. It has been compared with monotherapy in full patient populations and in non-responders, and has been compared with other drug combinations. Telmisartan/HCTZ provides significantly greater reductions in blood pressure than monotherapy, and significantly increases the percentage of patients who achieve target blood pressure. The reduction in blood pressure achieved by adding HCTZ to telmisartan is greater than that achieved by adding HCTZ to atenolol, despite the fact that telmisartan and atenolol monotherapy had similar efficacy. Telmisartan/HCTZ provides significantly greater reductions than losartan plus HCTZ in 24-h mean blood pressure, primarily due to a significantly greater effect in the risky, early morning hours. Telmisartan/HCTZ is effective and well-tolerated in the elderly, diabetics and African-American patients. Ongoing studies are comparing the efficacy of telmisartan/HCTZ with valsartan plus HCTZ and amlodipine plus HCTZ in overweight, hypertensive diabetics and in patients with isolated systolic hypertension – two patient groups who are particularly at risk of target organ damage.     

Nicardipine in the treatment of essential hypertension controlled 6-month-study comparing nicardipine with propranolol at rest and during exercise

Summary Thirty patients with mild to moderate essential hypertension entered a randomised double-blind parallel group study for 6 months to compare the effects of the new calcium channel blocker nicardipine 90 mg/day and propranolol 240 mg/day. Both drugs reduced systolic and diastolic blood pressures significantly in the supine and in standing positions. After 6 months of treatment, nicardipine had reduced the supine systolic and diastolic blood pressures by 16 and 17 mm Hg, respectively, and propranolol by 15 and 12 mm Hg. While propranolol treatment led to a marked decline in heart rate, nicardipine caused a small but statistically significant increase in heart rate throughout the study. Both drugs reduced blood pressure during maximal exercise, but propranolol had a greater effect. During exercise nicardipine did not affect the heart rate, whereas propranolol dramatically reduced it. Nicardipine did not produce any ECG changes at rest or during exercise. The side-effects for nicardipine were mild and were related to the vasodilatation induced by the drug. No abnormalities in routine blood chemical tests were found for either of the drugs. Nicardipine appears to be an effective single drug treatment for mild to moderate hypertension.