用动态血压监测的方法评价氯沙坦治疗原发性高血压的疗效

目的应用24h动态血压监测(ABPM)的方法评价氯沙坦治疗原发性高血压的降压疗效、谷/峰比值及药物不良反应.方法采用开放的方法,55例原发性高血压患者经1周药物洗脱期,2周安慰剂期后,服用氯沙坦50mg,每日一次.4周末坐位舒张压≥90 mmHg者,加量至氯沙坦100mg,每日一次继续服用4周.于安慰剂期末及治疗8周末各行ABPM和实验室检查一次.结果ABPM结果显示8周末较安慰剂期末于24h、日间(600-2200)、夜间(2200-600)的收缩压/舒张压分别下降(11.0±9.5/6.8±5.8)、(115±10.8/7.0±6.2)、(10.2±9.5/6.6±7.0)mmHg.降压T/P值SBP为74.5%,DBP为75.5%.有头晕2例,无咳嗽等药物不良反应.结论氯沙坦50-100mg,每日一次可以维持24h降压疗效,耐受性好.     

伊贝沙坦和缓释维拉帕米对高血压患者交感活性的影响

目的 用握力试验激活交感神经系统,评价服用伊贝沙坦和缓释维拉帕米8周后交感活性的变化。方法 48名轻中度高血压患者经2周安慰剂期后,随机分入伊贝沙坦组(n=24,150mg,每日1次)和缓释维拉帕米组(n=24,240mg,每日1次)。于安慰剂期末和药物治疗8周末各进行1次握力试验,并记录静息和负荷状态下的血压和心率。结果 伊贝沙坦组服药后静息收缩压和舒张压显著降低(P<0.01),下降幅度与缓释维拉帕米组无显著性差异(P>0.05)。握力试验中,服用伊贝沙坦后可使血压上升幅度从30.6±8.69/20.0±4.51mmHg降至15.2±5.90/14.3±4.26mmHg,疗效与缓释维拉帕米组相似。结论 服用伊贝沙坦不仅可降低静息血压,而且可降低负荷状态下的血压,其作用与缓释维拉帕米相似。     

动态血压监测比较复方依那普利与依那普利单药的疗效

目的：应用动态血压监测（ABPM）评价2种规格的复方依那普利片治疗高血压的疗效、谷/峰比值,并与依那普利单药比较,探讨中国人应用依那普利/氢氯噻嗪复方制剂的合适剂量组合.方法：经2周洗脱期,平均坐位舒张压（SeDBP）为95～114 mmHg,且ABPM检查平均舒张压≥82 mmHg的高血压患者,随机分为A,B,C三组,分别口服复方依那普利（E）10 mg/氢氯噻嗪（HCTZ）12.5 mg或E10 mg/HCTZ 6.25 mg或E10 mg,qd.治疗4周末,诊室SeDBP≥90 mmHg者剂量加倍,SeDBP＜90 mmHg者按原剂量治疗,继续治疗4周.于洗脱期末及治疗8周末各行ABPM和实验室检查1次.结果：治疗8周末,三组24 h,日间、夜间平均血压均较给药前明显下降,A组（n=24）降压幅度优于C组（n=23）（P＜0.05）,略高于B组（n=26）（P＞0.05）.B组降压幅度高于C组,但无显著差异.A,B,C组的DBP谷峰比值分别为78.88%,70.23%和45.75%.结论：复方依那普利片每日一次口服可24 h平稳降压,且E 10 mg与HCTZ 6.25 mg剂量组合为佳.     

吲哒帕胺缓释片治疗轻、中度高血压长时治疗的疗效观察

目的评价吲哒帕胺缓释片(1.5mg)治疗轻、中度高血压病的临床疗效及其延迟的长时效应.方法按照WHO/ISH的诊断标准,筛选出30例轻、中度原发性高血压患者,男12例,女1 8例,平均年龄52.7±1 1.0岁.经过2周的安慰剂洗脱期,进入8周的吲哒帕胺缓释片(1.5mg)的开放治疗期.于服安慰剂期末及冶疗2,4,6,8周末测坐位收缩压、舒张压及心率,并采用动态血压监测方法对患者行服安慰剂期末及治疗8周末30h动态血压监测(ABPM).结果经过8周治疗后,平均坐位收缩压/舒张压下降(23.4±1 5.5/9.5±7.7)mmHg,治疗2周即达统计学意义,P<0.001,并持续到8周.30hABPM与治疗前比较显示,平均收缩压/舒张压;前24h及25～30h较治疗前明显下降,分别13.2/6.4mmHg和12.1/5.0 mmHg,具有统计学显著性.结论吲哒帕胺缓释片是一类利尿扩血管降压药物,每日一次用药能有效控制30h的血压.     

伊贝沙坦与双氢克尿噻联合治疗高血压临床观察

目的对伊贝沙坦(Irb)与小剂量双氢克尿噻(HCT)联合治疗原发性高血压的疗效、安全性进行临床评价.方法 57例轻、中度原发性高血压患者经2周安慰剂后,服用Irb 150mg,每天1次.2周末坐位收缩压(SBP)≥18.6kPa(140mmHg)、舒张压(DBP)≥12kPa(90mmHg)者加服HCT 12.5mg,每天1次.继续服用2周后,仍坐位SBP≥18.6kPa、DBP≥12kPa者,Irb加量至300mg,每天1次,继续服用4周.分别观察安慰剂期末和服药8周末的24h动态血压监测(ABPM)值和实验室检查值的变化. 结果治疗8周后坐位SBP和DBP分别下降21.9%、17.1%,降压有效率98%. ABPM 24h平均血压、白昼夜间平均血压均明显下降(P<0.01),动态血压负荷值小于40%.无咳嗽等不良反应发生. 结论 Irb与小剂量HCT合用可提高血压控制率,减少药物副作用,耐受性好.     

伊贝沙坦与双氢克尿噻联合治疗高血压临床观察

目的　对伊贝沙坦 (Irb)与小剂量双氢克尿噻 (HCT)联合治疗原发性高血压的疗效、安全性进行临床评价。方法　 5 7例轻、中度原发性高血压患者经 2周安慰剂后 ,服用Irb 15 0mg ,每天 1次。 2周末坐位收缩压 (SBP)≥ 18.6kPa(140mmHg)、舒张压(DBP)≥ 12kPa(90mmHg)者加服HCT 12 .5mg ,每天 1次。继续服用 2周后 ,仍坐位SBP≥ 18.6kPa、DBP≥ 12kPa者 ,Irb加量至3 0 0mg,每天 1次 ,继续服用 4周。分别观察安慰剂期末和服药 8周末的 2 4h动态血压监测 (ABPM)值和实验室检查值的变化。结果　治疗 8周后坐位SBP和DBP分别下降 2 1.9%、17.1% ,降压有效率 98%。ABPM 2 4h平均血压、白昼夜间平均血压均明显下降 (P <0 .0 1) ,动态血压负荷值小于 40 %。无咳嗽等不良反应发生。结论　Irb与小剂量HCT合用可提高血压控制率 ,减少药物副作用 ,耐受性好     

伊贝沙坦(国产)与缬沙坦治疗轻、中度高血压病疗效观察——随机、双盲平行对照研究

目的通过伊贝沙坦(南京京华生物工程有限公司生产)与缬沙坦(北京诺华制药股份有限公司)的对比研究来评论伊贝沙坦(国产)对轻、中度原发性高血压病的降压疗效和安全性.方法53例轻、中度高血压病患者被随机、双盲分为两组,经口服安慰剂2周后,分别每日口服1次伊贝沙坦75～150mg(A组)或缬沙坦80～160mg(B组),治疗4周,观察用药前后坐位血压、心率变化,对比用药前后实验室检查,记录患者用药后的不良反应.结果治疗4周后,伊贝沙坦组舒张压降低13.3±8.7mmHg,缬沙坦组舒张压降低16.5±9.3mmHg.总有效率A组为76.0%,B组为84.0%.在药物的初始剂量下即能达到有效血压控制的患者数A组为72.0%,B组为68.0%.不良反应发生率A组为11.54%,B组为14.81%.两组患者治疗后与治疗前相比,血压下降有显著差异(P＜0.01),心率变化无显著差异(P＞0.05).降压幅度与总有效率两组间比较均无显著差异(P＞0.05).不良反应发生率两组间比较无显著差异(P＞0.05).结论口服伊贝沙坦75～150mg,每日1次,对轻、中度高血压病降压疗效确切,患者耐受性好.     

缬沙坦／氢氯噻嗪复方片剂与依那普利／氢氯噻嗪复方片剂治疗轻中度原发性高血压的疗效观察

目的：应用动态血压监测评价复方依那普利与复方缬沙坦治疗轻中度原发性高血压的降压疗效。方法：40例平均坐位舒张压（SeDBP）为95～114 mmHg,且动态血压监测检查24 h平均舒张压≥82 mmHg的轻中度原发性高血压患者,随机分为两组,接受复方依那普利（依那普利10 mg+氢氯噻嗪12.5 mg）,qd,或接受复方缬沙坦（缬沙坦80 mg+氢氯噻嗪12.5 mg）,qd,治疗8周。在洗脱期末及治疗8周末各行动态血压监测和实验室检查1次。实验结束3个月后原两组轻中度原发性高血压患者又经2周洗脱期后,交叉接受复方缬沙坦或复方依那普利均qd,治疗8周,在洗脱期末及治疗8周末各行ABPM和实验室检查一次。结果：动态血压监测结果显示,两组治疗后24 h平均收缩压、舒张压均显著降低（P<0.001）。复方依那普利组收缩压、舒张压降低较复方缬沙坦组略明显,但两组间比较无统计学差异;复方依那普利组收缩压、舒张压降低的谷峰比分别为60.45%和53.24%;复方缬沙坦组分别为85.22%和78.96%;两组谷峰比值均>50%能维持24 h降压。不良反应少。结论：复方依那普利与复方缬沙坦治疗原发性轻中度高血压,均能有效降低收缩压、舒张压。每日1次口服可维持24 h平稳降压。     

伊贝沙坦与氯沙坦随机对照治疗原发性高血压多中心临床试验

目的观察伊贝沙坦治疗轻中度原发性高血压的疗效和安全性.方法采用随机对照、双盲双模拟、多中心的研究方法,以氯沙坦为对照药.伊贝沙坦组134例,氯沙坦组135例,起始剂量分别为75mg.d-1和50mg.d-1;治疗第4周疗效未达到有效标准则加大剂量,疗程为8周;3 1例患者完成了治疗前后两次ABPM检查.结果二组服药8周后坐位DBP.分别降低了13.8±5.7mmHg和13.9±5.3mmHg,坐位SBP分别降低了20.4±10.8 mmHg和20.6±10.5 mmHg,治疗前后相比均有显著性差异;伊贝沙坦组总有效率为87.02%,氯沙坦组总有效率79.70%,两组比较无显著性差异;伊贝沙坦组SBP和DBP下降谷/峰比值分别为80.6%和69.6%;两药的药物不良反应发生率分别为12.03%和13.53%,均较轻,可耐受.结论国产伊贝沙坦片对轻中度原发性高血压的治疗作用和安全性与氯沙坦片基本相同.     

贝那普利/氨氯地平复方制剂与贝那普利单药对高血压患者动态血压的影响

目的:应用动态血压监测(ABPM)技术评价贝那普利/氨氯地平复方制剂与贝那普利单剂对动态血压的影响.方法:本研究为随机、双盲、平行对照研究.经2周洗脱期,口服贝那普利10 mg单药治疗后,平均坐位舒张压(SeDBP)≥90 mmHg、且经ABPM检查平均舒张压≥82 mmHg的高血压患者,随机分为贝那普利(10 mg)/氨氯地平(5 mg)复方制剂组(qd)和贝那普利单剂组(20 mg·d-1).治疗4周末,两组诊室SeDBP≥90 mmHg者剂量加倍,SeDBP<90 mmHg者维持原剂量继续治疗4周.结果:治疗8周末,两组24 h、日间及夜间平均血压均较给药前明显下降.复方制剂组与贝那普利单剂组DBP/SBP的谷/峰比率(T/P)为83.12%/75.98%和85.83%/79.47%.结论:贝那普利/氨氯地平复方制剂每日1次口/服耐受性良好,并能24 h平稳降压.     

动态血压监测评价西尼地平治疗原发性高血压的疗效

目的 应用动态血压监测(ABPM) 的方法评价西尼地平胶囊治疗原发性高血压的疗效. 方法 采用开放的方法, 22 例原发性高血压患者经2周洗脱期, 服用西尼地平胶囊5 mg, qd, 2 周末坐位舒张压(DBP) ≥90 mmHg 者加量至10 mg, qd, 继续服用6周. 于洗脱期末及治疗8周末各行ABPM 和实验室检查1次. 结果 ABPM 显示8 周末24 h 平均血压、日间平均血压、夜间平均血压、白昼平均收缩压（SBP）负荷、夜间平均DBP负荷均比治疗前明显降低, 差异有显著性或极显著性( P<0.05或P<0.01). 降低SBP和DBP谷峰比分别为0.61和0.50. 不良反应发生率低. 结论 西尼地平胶囊每天5～10 mg治疗原发性高血压安全有效.     

动态血压监测比索洛尔的降压作用

目的：观察比索洛尔(bisoprolol,Bsp)对轻、中度原发性高血压(EH)的降压效果及不良反应.方法：25例EH患者口服比索洛尔5 mg&#8226;d 1,早餐后一次顿服,服药前和服药4周后各行动态血压监测1次.结果：Bsp降压总有效率为92.0%,可持续24 h降压,白天降压幅度较夜间显著,可减慢心率,对收缩压及舒张压的谷值/峰值比分别为64.0%和71.0%.结论：Bsp有良好的降压作用,尤其适用于伴心肌缺血、心动过速的EH患者.     

Olmesartan Medoxomil-Based Antihypertensive Therapy Evaluated by Ambulatory Blood Pressure Monitoring

Hypertension affects approximately 26% of the world’s adult population and is a recognized major risk factor for morbidity and mortality associated with cardiovascular, cerebrovascular, and renal diseases. However, despite the availability of a range of effective antihypertensive agents and a growing awareness of the consequences of high blood pressure (BP), the treatment and control of hypertension remains sub-optimal. A number of patient subgroups are categorized as ‘high risk’ and may have hypertension that is more difficult to treat, including obese individuals, patients with stage 2 hypertension, those with type 2 diabetes mellitus (T2DM), patients with coronary artery disease or a history of stroke, and Black patients. As the benefits of lowering BP in patients with hypertension are unequivocal, particularly in high-risk patients, treating high-risk patients with hypertension to BP goals and maintaining 24-hour BP control is important to help reduce cardiovascular risk and improve outcomes. Although the BP goals recommended in current consensus guidelines for the management of patients with hypertension are based on cuff BP measurements, ambulatory BP monitoring (ABPM) provides a valuable diagnostic tool and allows a more accurate assessment of BP levels throughout the 24-hour dosing period. ABPM is a better predictor of prognosis than office BP measurement and is also useful for assessing whether antihypertensive therapy remains effective in the critical last few hours of the dosing period, which usually coincides with the morning BP surge associated with arousal and arising. ABPM has been adopted by new evidence-based guidelines in the United Kingdom to confirm a suspected diagnosis of hypertension, which is an indication of the growing importance of ABPM in the management of hypertension. This review provides an overview of the efficacy and safety of anti-hypertensive therapy based on olmesartan medoxomil ± hydrochlorothiazide and amlodipine/olmesartan medoxomil in high-risk patient populations enrolled in studies that reported ambulatory BP endpoints. The studies identified in this review showed that a titrate-to-BP goal strategy using olmesartan medoxomil- or amlodipine/olmesartan medoxomil-based antihypertensive therapy was an effective and well-tolerated approach for maintaining BP control throughout the full 24-hour dosing period in high-risk patients with difficult-to-treat hypertension.     

Circadian Variations in Blood Pressure

The management of hypertensive patients usually ignores or gives little credit to the biologic rhythms inherent to the disease process and their potential clinical implications. The development of ambulatory blood pressure monitoring and the rapidly growing popularity of home blood pressure measurements by patients have now generated a series of new clinical questions that are directly linked to the chronobiology of the cardiovascular system, such as the clinical interpretation of a blunted nocturnal fall in blood pressure or the difficulty of achieving adequate blood pressure control in the morning. Today, there is growing evidence that night-time blood pressure, and particularly the absence of a decrease in sleep blood pressure, contributes to the occurrence of target organ damages, and that the early morning rise in blood pressure increases the risk of developing cardiovascular events, including stroke, perhaps independently of 24-hour blood pressure levels. On the basis of these observations, it may be necessary to reconsider the way antihypertensive drugs are prescribed in order to obtain smooth, 24-hour blood pressure control, respecting the circadian pattern of blood pressure. Several approaches exist, including the use of drugs that lower blood pressure around the clock and respect the diurnal rhythm. Preliminary studies performed with such agents have provided interesting results. However, there is a clear need for large clinical trials demonstrating the clinical superiority of this approach. In any case, a better understanding of the importance of the circadian variations of blood pressure could certainly have a major impact on our view of the therapeutic management of hypertensive patients.     

Blood Pressure of Rats Lowered by Sulfur Dioxide and Its Derivatives

This study was designed to investigate effects of sulfur dioxide (SO 2) and its derivatives (bisulfite and sulfite) on the rat blood pressure. The blood pressures of male Wistar rats exposed to SO 2 and its derivatives at various doses were measured. Findings were that: (1) with acute-one time exposure to SO 2 for 6 h, the rat blood pressures were lowered in contrast to their controls and their background levels in a dose-dependent manner. (2) There were both a dose-response relationship and a time-response relationship between subchronic SO 2 exposure and the rat blood pressure. For SO 2 exposure at 10 ppm, first the blood pressures decreased significantly with exposure days in contrast to their controls and their background levels, and then these decreases became not significant, suggesting an adaption mechanism might be induced. However, SO 2 exposures at 40 ppm caused significant decreases of the blood pressures during the whole experiment, and no adaptation process was found. (3) SO 2 derivatives (bisulfite and sulfite) also caused the decreases of rat blood pressures in a dose-dependent manner. There are two conclusions: (1) Short-time, even acute one-time, exposure to SO 2 or its derivatives may cause a decrease of blood pressure of the animals in both dose-dependent and time-dependent manners. (2) SO 2 is a systemic toxic agent, not only to the respiratory system. SO 2 can cause at least functional damage to the cardiovascular system.     

比索洛尔治疗原发性高血压患者的疗效观察

目的：评价比索洛尔治疗原发性高血压患者诊室血压的安全性和疗效。方法：36例初诊的轻、中度原发性高血压患者接受比索洛尔治疗4周，检测治疗前后诊室血压、动态血压及生化指标的变化，并设有安慰剂对照组36例。结果：比索洛尔组显效10例，有效14例；对照组显效4例，有效10例，2组疗效差异有统计学意义（P〈0．05）。诊室血压、心率、24h血压、白天血压、夜间血压、最大血压和最小舒张压均有降低（P〈0．05），收缩压与舒张压的谷／峰比值分别为53％和69％。治疗前后生化指标变化差别无统计学意义。结论：比索洛尔是治疗原发性高血压安全有效的药物．对糖、脂代谢无明显影响。     

Assessing Pharmacy Students’ Ability to Accurately Measure Blood Pressure Using a Blood Pressure Simulator Arm

Objective. To compare student accuracy in measuring normal and high blood pressures using a simulator arm.Methods. In this prospective, single-blind, study involving third-year pharmacy students, simulator arms were programmed with prespecified normal and high blood pressures. Students measured preset normal and high diastolic and systolic blood pressure using a crossover design.Results. One hundred sixteen students completed both blood pressure measurements. There was a significant difference between the accuracy of high systolic blood pressure (HSBP) measurement and normal systolic blood pressure (NSBP) measurement (mean HSBP difference 8.4 ± 10.9 mmHg vs NSBP 3.6 ± 6.4 mmHg; p<0.001). However, there was no difference between the accuracy of high diastolic blood pressure (HDBP) measurement and normal diastolic blood pressure (NDBP) measurement (mean HDBP difference 6.8 ± 9.6 mmHg vs. mean NDBP difference 4.6 ± 4.5 mmHg; p=0.089).Conclusions. Pharmacy students may need additional instruction and experience with taking high blood pressure measurements to ensure they are able to accurately assess this important vital sign.     

左旋氨氯地平治疗原发性高血压动态血压观察

目的利用动态血压监测技术观察左旋氨氯地平治疗原发性高血压降压疗效。方法选取80例轻中度高血压患者,试验前未服用降压药物或停用其他降压药物1周以上,,给予口服左旋氨氯地平2.5mg/d,连续用药4周,降压疗较差者加量至5mg/d,所有患者于药物治疗前和治疗4周后进行24h动态血压监测。结果左旋氨氯地平能明显降低诊室血压(P<0.05)和24h血压(P<0.05),不良反应发生率低。结论左旋氨氯地平可有效降低轻中度高血压患者诊所血压和24h血压,不良反应少。     

血脂康联合降压治疗对动态血压及血压变异性的影响

目的观察调脂联合降压治疗对动态血压及血压变异性(blood pressure variability,BPV)的影响。方法 110例诊断为高血压病的患者随机分为单纯降压组和调脂降压治疗组,调脂降压治疗组在降压基础上加用血脂康600 mg,2次/d,所有患者均于治疗前及治疗6个月后行血脂及动态血压检查,记录24h平均收缩压(24hSBP)及24h平均舒张压(24hDBP),计算均数标准差(24hSBPV、24hDBPV)和24h动态脉压(24hPP),比较两组患者治疗前后血脂及动态血压值及其稳定性的变化。结果 6个月后两组血压控制良好,PP及SBPV均降低(P<0.05);调脂降压治疗组血脂水平明显降低(P<0.01),PP低于单纯降压组(P<0.05),调脂降压治疗组SBPV较单纯降压组降低(24hSBPVP<0.05)。结论降压治疗能降低PP和SBPV,应用血脂康协同降压治疗能进一步降低血压的PP和SBPV。