缬沙坦／氨氯地平和依贝沙坦／双氢克尿噻联合治疗老龄高血压疗效的研究

目的 比较缬沙坦/氨氯地平和依贝沙坦/双氢克尿噻两种联合用药对老龄高血压患者的疗效.方法 经过4周药物洗刷期,94例老龄高血压患者被随机分为缬沙坦160 mg/氨氯地平5 mg和依贝沙坦300 mg/双氢克尿噻12.5 mg两组,治疗周期为24周,对于药物治疗4周后无反应的患者氨氯地平或双氧克尿噻加倍剂量给药.观察期间测定卧位、坐位及立位血压（收缩压和舒张压）和心率,治疗结束后并测定尿酸和血钾数值.结果 用药后两组各自的血压值均明显下降（氨氯地平和双氢克尿噻剂量加倍者分别为9例和11例）,但两组间的比较差异无统计学意义（P＞0.05）,从卧位到站立血压下降在依贝沙坦/双氢克尿噻组中比缬沙坦/氨氯地平组更明显,分别为-17.2/-9.1 mmHg和-10.1/-1.9mmHg（SBP：t=2.14,P＜0.05,DBP：t=3.11,P＜0.01）.在依贝沙坦/双氢克尿噻组中,相对治疗前血钾水平明显降低（-0.4 mmol/L,t=2.33,P＜0.05）,尿酸明显升高（＋29.7 μmol/L,t=2.54,P＜0.05）.结论 两组药物均能显著降低老龄患者的高血压状况,但缬沙坦/氨氯地平组在对由体位改变引起的血压变化情况影响较小,且有较少的代谢副作用.     

The effective diagnosis and treatment of hypertension by the primary care physician: impact of ambulatory blood pressure monitoring.

BACKGROUND: Ambulatory blood pressure monitoring (ABPM) has been described as an effective method for the diagnosis and formulation of the treatment of hypertension by the primary care physician. METHODS: Sixty patients selected from a suburban private primary care practice participated in a study that compared measurements of office blood pressures using a mercury sphygmomanometer with the same pressures recorded by ABPM. RESULTS: Blood pressures and blood pressure loads measured by ABPM were significantly lower than blood pressures and pressure loads recorded in the office setting. CONCLUSIONS: Blood pressure recorded by ABPM differed from the same measurements made by office or casual sphygmomanometry. Use of ABPM changed diagnosis or treatment of hypertension in borderline and antihypertensive drug-treated patients. Ambulatory blood pressure monitoring is a useful tool for the diagnosis and treatment of hypertension by the primary care physician. It can be used to identify white-coat hypertension in various patient populations.     

替米沙坦对原发性高血压伴左心室肥厚的疗效观察

目的探讨替米沙坦对原发性高血压伴左室肥厚患者的疗效观察。方法 84例原发性高血压伴左心室肥厚患者停用降压药2周后被随机分为两组,治疗组给予替米沙坦80mg,每天1次,对照组给予卡托普利25mg,每天3次,药物剂量根据患者血压情况调整,观察6个月;比较两组病人治疗前后血压、左心室肥厚超声心动图指标变化。结果治疗组与对照组血压均降低,治疗前后差异显著(P<0.01),两组比较差异无显著意义(P>0.05);两组左心室肥厚均逆转,治疗前后差异显著(P<0.05),两组相比差异无显著意义(P>0.05)。结论替米沙坦与卡托普利均能有效地降低血压,同时逆转左心室肥厚。     

Application in the STRATHE trial of a score system to compare the efficacy and the tolerability of different therapeutic strategies in the management of hypertension

A score system integrating the evolution of efficacy and tolerability over time was applied to a subpopulation of the STRATHE trial, a trial performed according to a parallel group design, with a double-blind, random allocation to either a fixed-dose combination strategy (perindopril/indapamide 2 mg/0.625 mg, with the possibility to increase the dose to 3 mg/0.935 mg, and 4 mg/1.250 mg if needed, n = 118), a sequential monotherapy approach (atenolol 50 mg, followed by losartan 50 mg and amlodipine 5 mg if needed, n = 108), or a stepped-care strategy (valsartan 40 mg, followed by valsartan 80 mg and valsartan 80 mg+ hydrochlorothiazide 12.5 mg if needed, n = 103). The aim was to lower blood pressure below 140/90 mmHg within a 9-month period. The treatment could be adjusted after 3 and 6 months. Only patients in whom the study protocol was strictly applied were included in this analysis. At completion of the trial the total score averaged 13.1 +/- 70.5 (mean +/- SD) using the fixed-dose combination strategy, compared with -7.2 +/- 81.0 using the sequential monotherapy approach and -17.5 +/- 76.4 using the stepped-care strategy. In conclusion, the use of a score system allows the comparison of antihypertensive therapeutic strategies, taking into account at the same time efficacy and tolerability. In the STRATHE trial the best results were observed with the fixed-dose combination containing low doses of an angiotensin enzyme converting inhibitor (perindopril) and a diuretic (indapamide).     

缬沙坦治疗老年高血压病疗效观察

目的评价缬沙坦治疗老年1、2级高血压病的临床疗效。方法选取1、2级老年高血压病患者68例,随机分为两组,每组34例。治疗组给予缬沙坦80mg/d,清晨口服;对照组给予长效钙拮抗剂氨氯地平5mg/d,清晨口服。比较患者服药前及服药8周末血压测量值。结果8周末,治疗组总有效率88.2%,SBP/DBP下降34.8±11.2/12.6±6.2mmHg;对照组总有效率88.2%,SBP/DBP下降32.3±8.6/11.8±6.9mmHg。两组间总有效率及血压下降值差异无统计学意义（P〉0.05）,说明两药降压疗效相似。结论缬沙坦80mg/d治疗老年人1、2级高血压病疗效确切,患者耐受性好,不良反应少,是治疗老年高血压病的理想药物。     

苯磺酸左旋氨氯地平和替米沙坦联合治疗原发性高血压

目的 观察以左旋氨氯地平为主的不同降压方案治疗原发性高血压的临床疗效.方法 纳入139例患者,70例为联合应用苯磺酸左旋氨氯地平和替米沙坦治疗;69例为对照组单独应用苯磺酸左旋氨氯地平治疗;苯磺酸左旋氨氯地平2.5 mg,1次/d,替米沙坦40 mg,1次/d,用药1周后未能达到目标血压,则苯磺酸左旋氨氯地平增至5 mg,替米沙坦增至80 mg,服用6周评价药物的有效性和安全性.结果 联合组治疗6周后总有效率为92.9％,对照组总有效率87.0％,且两组血压均比治疗前显著降低,差异有显著性意义（P＜0.05）.结论 联合应用苯磺酸左旋氨氯地平和替米沙坦治疗原发性高血压提高了疗效,并且安全.     

替米沙坦对代谢综合征合并高血压患者内脏脂肪沉积的影响

目的观察替米沙坦对代谢综合征（MS）合并原发性高血压（EH）患者内脏脂肪沉积的影响。方法选择合并MS的EH患者60例,按随机数字表法分为两组,每组30例,试验组给予替米沙坦40mg,1次／d治疗;对照组给予缬沙坦80mg,1次／d治疗,直至24周动态血压监测平均血压〈140／90mmHg（1mmHg：0．133kPa）,采用多层螺旋CT影像学检查受试者皮下脂肪面积（SFA）和内脏脂肪面积（VFA）,同时检测体质量指数（BMI）、血压、血糖、胰岛素抵抗指数（HOMA—IR）、糖化血红蛋白（HbA1c）水平。结果两组治疗前血压、BMI、血糖、HbA1c、血脂等一般临床资料比较差异无统计学意义（P〉0．05）;试验组治疗后VFA较治疗前显著降低[（127．8±16．6）cm2比（150．5±15．4）cm2],差异有统计学意义（P〈0．05）,对照组治疗前后VFA比较差异无统计学意义（P〉0．05）;试验组和对照组治疗前后SFA均无明显改变,差异无统计学意义（P〉0．05）;试验组治疗后HOMA—IR较治疗前显著降低（1．9±0．3比4．2±0．9）,血清脂联素水平较治疗前显著增加[（5．77±0．71）mg／L比（3．16±0．72）mg／L],差异有统计学意义（P〈0．05）。结论与缬沙坦比较,替米沙坦可显著减少MS合并EH患者内脏脂肪沉积,改善胰岛素抵抗。     

大剂量雷米普利联合替米沙坦治疗糖尿病肾病

目的观察大剂量血管紧张素转换酶抑制剂联合血管紧张素受体拮抗剂治疗糖尿病肾病的疗效。方法68例糖尿病肾病患者被随机分为常规剂量雷米普利组和大剂量雷米普利组,均联合同等剂量的替米沙坦。治疗方案：常规剂量组给予雷米普利2．5mg／次,2次／d,口服。大剂量组给予雷米普利5mg/次,2次／d,口服。两组均联合应用替米沙坦80mg／d,观察治疗后3个月和6个月后,两组24h尿蛋白定量、血浆白蛋白、血肌酐、血钾水平以及血压的变化。结果两组在治疗6个月后24h尿蛋白定量均下降,血浆白蛋白均升高,与治疗前相比差异具有显著意义（P〈0．05）;大剂量组上述指标的变化更明显,与常规剂量组相比差异具有显著性（P〈0．05）;均能有效降压,大剂量雷米普利组降舒张压优于常规剂量组;两组治疗前后血钾和肾功能无统计学意义（P〉0．05）。结论大剂量血管紧张素转换酶抑制剂治疗糖尿病肾病安全,联合血管紧张素受体拮抗剂治疗有双重阻断。肾素血管紧张素系统的作用,并且大剂量血管紧张素转换酶抑制剂联合血管紧张素受体拮抗剂更有效。     

Olmesartan medoxomil combined with hydrochlorothiazide for the treatment of hypertension

In most patients with hypertension, especially Stage 2 hypertension, adequate control of blood pressure (BP) is only achieved with combination drug therapy. When using combination therapy, antihypertensive agents with complementary mechanisms of action are recommended, for example, an angiotensin receptor blocker (ARB) in combination with hydrochlorothiazide (HCTZ), a beta-blocker + HCTZ, an ACE inhibitor + HCTZ, or a calcium channel blocker + an ACE inhibitor. One such combination is olmesartan medoxomil + HCTZ, which is available as fixed-dose, single-tablet combinations for once-daily administration. In clinical trials, olmesartan medoxomil/HCTZ reduced systolic BP (SBP) and diastolic BP (DBP) to a greater extent than either component as monotherapy. A clinical study in patients with Stage 1 or 2 hypertension showed that olmesartan medoxomil/HCTZ achieved a similar mean reduction in DBP, but a significantly greater mean reduction in SBP and higher rate of BP control (< 140/90 mmHg) than observed with losartan/HCTZ, at US/European-approved starting doses. In a non-inferiority trial, the antihypertensive efficacy of olmesartan medoxomil/HCTZ was comparable to that of atenolol/HCTZ. Furthermore, indirect comparisons have shown that olmesartan medoxomil/HCTZ compares favorably with other antihypertensive combination therapies, including other ARB/HCTZ combinations and amlodipine besylate/ benazepril. Olmesartan medoxomil/HCTZ is generally well tolerated. In conclusion, olmesartan medoxomil/HCTZ is an effective and well-tolerated combination antihypertensive therapy that results in significant BP reductions and BP control in many patients.     

舒洛地特联合缬沙坦对高血压肾损害患者肾功能和尿蛋白的影响

目的观察舒洛地特联合缬沙坦治疗对高血压肾损害患者肾功能和尿蛋白的影响。方法60例高血压肾损害患者均进行基础治疗，然后随机分为两组，对照组30例，每天晨服缬沙坦胶囊80mg；治疗组30例，在对照组治疗基础上加服舒洛地特胶囊250LSU，每日2次。两组疗程均为3个月。检测治疗前后血肌酐（Scr）、尿素氮（BUN）、血尿酸（uA）、血清光抑素C（cystatin C）、24h尿蛋白、尿β2－微球蛋白（β2－MG）、尿旺。微球蛋白（α1－MG）、尿N－乙酰－β－D葡萄糖苷酶（NAG）。结果与治疗前相比，两组治疗后BUN、Cr、UA无明显变化（P〉0．05），cystatinC均明显减少（P〈0．01），而治疗组血cvstatin C减少更加明显（P〈O．01）；两组治疗后24h尿蛋白定量、尿α1－MG、β2－MG、NAG均明显减少（P〈O．01），而治疗组24h尿蛋白定量、尿仪。α1－MG、β2－MG、NAG减少更加咀显（P〈0．01）。结论舒洛地特联合缬沙坦治疗比单纯应用缬沙坦治疗能够更有效地降低2型糖尿病肾病患者的尿蛋白，对肾脏具有良好的保护作用。     

替米沙坦对原发性高血压伴左心室肥厚的疗效观察

目的探讨替米沙坦对原发性高血压伴左室肥厚患者的疗效观察。方法 84例原发性高血压伴左心室肥厚患者停用降压药2周后被随机分为两组,治疗组给予替米沙坦80mg,每天1次,对照组给予卡托普利25mg,每天3次,药物剂量根据患者血压情况调整,观察6个月;比较两组病人治疗前后血压、左心室肥厚超声心动图指标变化。结果治疗组与对照组血压均降低,治疗前后差异显著(P<0.01),两组比较差异无显著意义(P>0.05);两组左心室肥厚均逆转,治疗前后差异显著(P<0.05),两组相比差异无显著意义(P>0.05)。结论替米沙坦与卡托普利均能有效地降低血压,同时逆转左心室肥厚。     

Fixed combination of zofenopril plus hydrochlorothiazide in the management of hypertension: a review of available data

Angiotensin-converting enzyme (ACE) inhibitors effectively interfere with the renin-angiotensin system and exert various beneficial actions on vascular structure and function beyond their blood pressure-lowering effects. Zofenopril, a potent sulphydryl ACE inhibitor, is characterized by high lipophilicity, sustained cardiac ACE inhibition, and antioxidant and tissue protective activities. Its ancillary properties, such as antioxidant activity and cardiovascular (CV) protection, make this drug potentially suitable for the treatment and prevention of certain CV diseases. The Survival of Myocardial Infarction Long term Evaluation trials have demonstrated that the early administration of zofenopril to patients with acute myocardial infarction is associated with a significant reduction in the 6-week occurrence of major CV events in high-risk patients with anterior non-thrombolyzed myocardial infarction. The fixed combination of zofenopril-hydrochlorothiazide (HCTZ) 30/12.5 mg/day is approved for the management of mild-to-moderate hypertension in different European countries. In clinical trials comparing zofenopril-HCTZ with each agent administered as monotherapy, combination therapy was clearly more effective in normalizing blood pressure (BP). In addition, combination therapy provided sustained and consistent BP control over the entire 24 hour dosing interval. The efficacy and safety profile of zofenopril-HCTZ highlights that this combination is a potentially useful addition to currently available therapy for patients with BP inadequately controlled by monotherapy, as well as for patients who require more rapid and intensive BP control.     

Inhibition of platelet aggregation and angiotensin II-receptor blockade following TIA; the unexpected results of the Prevention Regimen For Effectively Avoiding Second Strokes (PROFESS) trial

In the Prevention Regimen for Effectively Avoiding Second Strokes (PROFESS) trial, the combination of acetylsalicylic acid (50 mg) and extended-release dipyridamole (400 mg) (ASA+Dip) was compared with clopidogrel (75 mg) in patients with a recent transient ischaemic attack (TIA) or minor disabling stroke. In the same patients, the selective type I angiotensin II-receptor blocker telmisartan (80 mg) was compared with placebo. Both comparisons did not show any benefit or harm from any of the treatments evaluated. Therefore, ASA+Dip and clopidogrel should be considered effective in secondary stroke prevention following TIA or minor disabling stroke. ASA+Dip caused headache in 6% of patients. Clopidogrel can cause severe haematological side effects in rare cases; its use is hampered mainly by its high cost. Telmisartan was well tolerated in patients with a recent TIA or minor disabling stroke but should not be used for indications other than lowering blood pressure.     

厄贝沙坦氢氯噻嗪片对血压晨峰及左心室质量相关参数的影响

目的 观察厄贝沙坦氢氯噻嗪片对中老年原发性高血压患者血压晨峰(MBPS)及左心室质量(LVM)相关参数的影响.方法 选择120例轻中度原发性高血压患者,口服厄贝沙坦氢氯噻嗪片150 ms/12.5 mg,4～8周不达标者剂量加倍,治疗12个月,应用动态血压监测(ABPM)评价治疗前后MBPS的变化,应用超声心动图评价LVM相关参数的变化.结果 (1)经厄贝沙坦氢氯噻嗪片治疗后,MBPS(+)的患者减少,MBPS(-)的患者增多,与治疗前比较差异有统计学意义(P<0.01).(2)治疗后MBPS(+)患者晨峰程度较治疗前明显降低[收缩压(SBP)差值(16.1±1.8)mm Hg(1 mm Hg=0.133 kPa)比(29.4±2.8)mm Hg,舒张压(DBP)差值(10.2±2.3)mm Hg比(21.2±2.2)mm Hg,P<0.01],而MBPS(-)患者晨峰程度较治疗前无明显下降[SBP差值(11.2±2.4)mm Hg比(10.1±1.2)mm Hg,DBP差值(5.9±1.9)mm Hg比(6.8±3.2)mm Hg].(3)MBPS(+)和MBPS(-)患者治疗后LVM相关参数较治疗前均明显减小,且MBPS(+)患者治疗后左心室后壁厚度、LVM、LVM指数与MBPS(-)患者治疗后比较差异有统计学意义(P<0.05).结论 厄贝沙坦氢氯噻嗪片能有效遏制MBPS的发生,降低晨峰程度,并能逆转左心室肥厚.     

左旋氨氯地平联合倍他乐克治疗血压晨峰的临床观察

目的采用动态血压监测（ABPM）,观察苯磺酸左旋氨氯地平联合倍他乐克对轻、中度原发性高血压患者血压和血压晨峰（MBPS）影响。方法选择96例轻、中度血压曲线呈超杓型的原发性高血压患者,随机分为两组．对照组予苯磺酸左旋氨氯地平2．5mg晨醒时口服,观察组另晨醒时加服倍他乐克25mg。6周后复查24hABPM．评价血压及MBPS程度的变化。结果治疗前两组24h平均血压,清晨平均血压,IN-＆峰值差异均无统计学意义;而治疗6周后,观察组较对照组降低更显著（P〈0．01）,而夜间最低血压两组比较差异无统计学意义（P〉0．05）。结论对具有MBPS现象的原发性高血压患者的治疗．苯磺酸左旋氨氯地平联合倍他乐克晨醒时单次服药较单用苯磺酸左旋氨氯地平能更好地控制24h平均血压、清晨高血压及睡一谷峰值。     

替米沙坦对动脉粥样硬化兔肝脏组织Se含量的影响

目的探讨替米沙坦对实验性动脉粥样硬化兔肝脏组织中Se含量的变化。方法用高脂饮食复制兔动脉粥样硬化,然后给予替米沙坦建立治疗组模型,获取肝脏,用硝酸、过氧化氢混合液微波消解样品,采用原子荧光光谱法测定肝脏组织中Se的含量。结果正常组饲料和高脂组饲料Se含量分别为0.21、0.64mg/Kg,正常组、高脂组和治疗组Se在肝脏组织中含量分别为3.3075mg/Kg、2.1391mg/Kg和1.7800mg/Kg。结论给予替米沙坦治疗后,替米沙坦治疗组的Se平均含量比高脂组的平均含量下降37.36%,替米沙坦可能对Se的吸收有明显抑制作用。     

不同类型降压药物对老年高血压患者动脉僵硬度的影响

目的评价不同类型降压药物对老年原发性高血压患者动脉僵硬度的影响。方法60例老年男性原发性高血压患者,随机分为缬沙坦组（80mg,l/d）、贝那普利组（10mg,l/d）、硝苯地平缓释片组（20mg,2／d）各20例,疗程共3个月。分析治疗前后肱一踝脉搏波速度（baPWV）及血压。结果治疗3个月后各组血压均有显著降低,硝苯地平缓释片组舒张压的下降幅度（△DBP）、脉压下降幅度（△PP）与另两组差异显著（分别为-40．1±11．3 vs-16．6±5．5、-14．6±4．2mmHg和-10．0±19．3vs -28．8±6．6、-25．7±6．5mmHg,P〈0．01）。缬沙坦组及贝那普利组治疗前后baPWV均显著下降,其下降幅度（AbaPWV）分别为-401±90、-280±97cm／s,显著大于硝苯地平缓释片组的-11±127cm／s（P〈0．01）。baPWV与APP在总体患者中呈显著正相关（r=0．64．P〈0．001）,贝那普利组或硝苯地平缓释片组ΔbaPWV至少与一项血压参数（APP,ASBP,ADBP）相关,而在缬沙坦组均不相关。结论与贝那普利或硝苯地平缓释片相比,缬沙坦对老年原发性高血压患者具有独立于降压功效外的减低动脉僵硬度的作用。     

Is the fixed-dose combination of telmisartan and hydrochlorothiazide a good approach to treat hypertension?

Blockade of the renin-angiotensin system with selective AT1 receptor antagonists is recognized as an effective mean to lower blood pressure in hypertensive patients. Among the class of AT1 receptor antagonists, telmisartan offers the advantage of a very long half-life. This enables blood pressure control over 24 hours using once-daily administration. The combination of telmisartan with hydrochlorothiazide is a logical step because numerous previous studies have demonstrated that sodium depletion enhances the antihypertensive efficacy of drugs interfering with the activity of the renin-angiotensin system (RAS). In accordance with past experience using similar compounds blocking the RAS, several controlled studies have now demonstrated that the fixed-dose combination oftelmisartan/hydrochlorothiazide is superior in lowering blood pressure than either telmisartan or hydrochlorothiazide alone. Of clinical interest also is the observation that the excellent clinical tolerance of the angiotensin II receptor antagonist is not affected by the association of the low-dose thiazide. Thus telmisartan/hydrochlorothiazide is an effective and well-tolerated antihypertensive combination. Finally, the development of fixed-dose combinations should improve drug adherence because of the one-pill-a-day regimen.     

不同服药时间对老年非杓型高血压患者夜间血压的影响

目的探讨早晨或夜间服用长效钙拮抗剂氨氯地平对老年非杓型高血压患者夜间血压的影响。方法选取122例2级非杓型原发性高血压患者,随机分为早晨服药组（A组）和晚间服药组（B组）治疗2周,治疗前后分别进行诊室血压和动态血压监测的检查。结果 （1）两组患者的诊室收缩压（SBP）和舒张压（DBP）均明显降低（P〈0.05）,两组之间诊室血压下降差值的比较差异无统计学意义（P〉0.05）。（2）动态血压监测结果显示早晨服药和晚间服药均能降低24 h平均收缩压（24 hSBP）2、4 h平均舒张压（24 hDBP）、白昼平均收缩压（dSBP）、白昼舒张压（dDBP）、夜间平均收缩压（nSBP）和夜间舒张压（nDBP）,差异有统计学意义（P〈0.05）。（3）晚间服药组患者24 h平均收缩压（24 hSBP）和夜间平均收缩压（nSBP）明显低于早晨服药组患者（P〈0.05）。结论早晨或晚间服用长效钙拮抗剂均能有效降低老年非杓型高血压患者的血压值,晚间服药组患者能更有效的降低夜间血压。     

原发性高血压血压波动性与C反应蛋白的关系

目的 探讨原发性高血压血压波动性(BPv)与CRP的关系.方法 选择64例原发性高血压患者,按有无靶器官损伤(TOD)分为TOD组(34例)和无TOD组(30例),行动态血压监测,以变异系数(CV)作为评价BPV的指标,并与对照组30例进行比较,采用免疫比浊法检测各组hs-CRP水平.同时以平均CV值为界将64例患者分为高CV组和低CV组,比较高CV组、低CV组和对照组hs-CRP水平的变化.结果 24 h收缩压的CV值及hs-CRP水平在TOD组[(16.12±2.17)%、(7.11±1.04)mg/L]和无TOD组[(13.30±2.64)%、(4.67±1.24)mg/L]与对照组[(10.68±2.19)%、(1.68±1.49)mg/L]比较差异均有统计学意义(P均<0.05),而且TOD组与无TOD组比较,差异也有统计学意义(P<0.05).高CV组(32例)、低CV组(32例)和对照组之间hs-CRP水平也显示了明显的差异.结论 炎性反应参与了血压波动,影响疾病的发生与发展.