贝尼地平和厄贝沙坦联合治疗对高血压病患者肾脏影响的临床研究

目的探讨贝尼地平、厄贝沙坦单独治疗和联合治疗对高血压病患者肾脏的影响。方法132例高血压病患者随机均分为3组：贝尼地平组（口服贝尼地平4mg）、厄贝沙坦组（口服厄贝沙坦150mg）;联合治疗组（口服贝尼地平4mg和厄贝沙坦150mg）。疗程24周,治疗前后观察肾脏病常用实验室检查的变化。结果3组高血压病患者治疗后降低血压及尿蛋白排泄量（24h尿白蛋白、24h尿蛋白、血尿B：-微球蛋白）比较,差异有非常显著意义。联合治疗组降低尿蛋白排泄的幅度与贝尼地平组和厄贝沙坦组比较,差异有统计学意义,而贝尼地平组和厄贝沙坦组之间无统计学意义。治疗后肾小球滤过率在联合治疗组及厄贝沙坦组之间,差异有统计学意义,而贝尼地平组无明显变化。3组治疗后尿白蛋白下降幅度与血压下降程度均无显著相关性。结论贝尼地平、厄贝沙坦长期单独治疗均可减少蛋白尿,保护肾脏,两药联合治疗对减少蛋白尿,保护肾脏有一定协同作用。     

培哚普利吲达帕胺复方制剂对盐敏感性高血压患者血压控制及靶器官损害的影响

目的:探讨培哚普利吲达帕胺复方制剂治疗盐敏感性高血压的临床应用价值。方法:60例高血压患者根据盐敏感性检测结果分为盐敏感性高血压组(A组)与非盐敏感性高血压组(B组),每组30例。两组均给予培哚普利吲达帕胺片治疗,连续治疗4周,对比两组治疗前后血压水平、治疗后靶器官损害指标[左心室重量指数(LVMI)、血清尿酸(UA)、血清肌酐(Cr)]水平变化。结果:治疗后两组SBP、DBP水平较治疗前降低(P0.05),且A组SBP、DBP水平低于B组(P0.05);治疗后A组LVMI减小及血清UA、Cr水平下降程度大于B组(P0.05)。结论:培哚普利吲达帕胺复方制剂对盐敏感性高血压的临床效果及靶器官保护作用尤为显著。     

缬沙坦氨氯地平(倍博特)治疗老年蛋白尿临床疗效观察

目的 研究缬沙坦氨氯地平(倍博特)治疗老年蛋白尿的临床疗效.方法 选取我院120例老年蛋白尿异常患者为研究对象,抽签随机分为A、B、C三组,三组均为40例,A组采取氨氯地平片治疗,5 mg/d;B组给予缬沙坦80 mg/d;C组给予缬沙坦氨氯地平(80 mg:5mg)/d;三组均治疗6个月,于治疗前、治疗3月及治疗6月后观察两组血压指标变化及治疗前后尿蛋白水平差异.结果 用药前三组SBP及DBP比较差异无统计学意义(P＞0.05),治疗3月后三组SBP及DBP与治疗前比较均降低,C组SBP、DBP显著低于A、B组,治疗6月后C组血压指标显著低于A、B组,而A、B组比较差异无统计学意义(P＞0.05);B、C三组治疗前Pro、BUN、 SCr比较差异无统计学意义(P＞0.05),治疗后三组Pro、BUN、SCr均降低,且C组治疗后Pro、BUN、SCr均显著低于A、B组,差异有统计学意义(P＜0.05).结论 缬沙坦氨氯地平治疗老年蛋白尿较单一应用缬沙坦或氨氯地平疗效更为显著,可改善尿蛋白水平、血压等指标,具有较高的临床应用价值.     

贝尼地平联合贝那普利治疗高血压肾病的疗效观察

目的 观察贝尼地平联合贝那普利治疗高血压肾病的临床疗效.方法 120例高血压肾病患者随机分为3组:A组口服贝尼地平一日4 mg、B组口服贝那普利一日10mg、C组联用贝尼地平和贝那普利治疗,用法用量同A、B组.疗程均为12周,观察治疗前后3组患者血压和肾功能变化以及不良反应.结果 与治疗前相比,治疗后3组患者血压和24 h尿蛋白定量均明显降低(P＜0.01),且与A组和B组比较,C组降低更为显著(P＜0.01).3组均未见严重不良反应发生.结论 贝尼地平联合贝那普利治疗高血压肾病可有效控制血压,降低24 h尿蛋白,疗效及安全性好.     

单硝酸异山梨酯与盐酸贝尼地平对老年单纯收缩期高血压的降压作用

目的观察单硝酸异山梨酯(ISMN)与盐酸贝尼地平对老年单纯收缩期高血压(ISH)患者的降压作用.方法96例ISH患者随机分为单硝酸异山梨酯组(31例)、贝尼地平组(33例)、联合用药组(32例).其中单硝酸异山梨酯组采用ISMN口服20 ng,bid;贝尼地平组予以盐酸贝尼地平片4 mg·d-1;联合用药组合用ISMN与贝尼地平内服.疗程均为8周.结果ISMN组用药后收缩压(SBP)显著下降(P＜0.01),舒张压(DBP)用药前后差异无显著性(P＞0.05);贝尼地平组SBP、DBP用药后均有显著下降(P＜0.01);联合用药组用药后SBP下降非常显著(P＜0.01),与贝尼地平组比较,差异亦非常显著(P＜0.01),但DBP仅有轻度下降(P＜0.05).ISMN组与联合用药组的脉压(PP)均明显减小,与贝尼地平组比较,差异均有显著性(P＜0.01).用药期间未见ISMN与贝尼地平的严重不良反应.结论ISMN能降低ISH患者的SBP,而对DBP影响不大,从而使PP减小,有利于ISH患者的降压治疗.ISMN合贝尼地平是治疗老年ISH较理想的联合用药.     

缬沙坦及贝尼地平对原发性高血压伴蛋白尿患者肾脏保护作用的研究

目的探讨缬沙坦与贝尼地平对原发性高血压伴蛋白尿患者的疗效及保护肾脏差别。方法随机选取2009年1月至2011年1月就诊我院的原发性高血压伴蛋白尿患者286例,分为A组(143例)和C组(143例),分别采用缬沙坦与贝尼地平治疗24周,对比两组患者治疗后的高血压总有效率、血清肌酐、肌酐清除率、尿微量蛋白的变化情况。结果经治疗后,两组患者血压控制总有效率相似,肌酐清除率均升高,血清肌酐及尿微量蛋白均降低,两组之间差异无统计学意义,P>0.05。结论缬沙坦及贝尼地平均能通过不同的途径有效地控制血压,保护肾脏,且疗效相当。     

美托洛尔联合培哚普利对慢性心力衰竭患者心功能的影响

目的 评价美托洛尔与培哚普利联合治疗慢性充血性心力衰竭(CHF)的临床疗效.方法 将182例CHF患者随机分为两组:对照组88例和治疗组94例.所有患者均经过常规的心衰治疗.对照组在常规的治疗基础上加用培哚普利;治疗组在常规的治疗基础上加用美托洛尔和培哚普利,观察两组治疗前后左心室舒张末内径(LVEDd)、左心室射血分数(LVEF)、心率(HR)、SBP、DBP的变化.结果 治疗组有效率为(87.2%)高于对照组(69.3%).治疗组SBP、DBP、HR、LVEF、6 min步行距离均显著改善(P<0.05).结论美托洛尔联合培哚普利治疗CHF可明显心功能,改善左室重构,提高生存率,改善预后.     

培哚普利联合氨氯地平对老年高血压左室结构及功能的影响

目的:探索血管紧张素转换酶抑制剂培哚普利联用钙拮抗剂氨氯地平对逆转老年高血压病患者左室结构及功能影响。方法:老年高血压LVH患者46例,口服氨氯地平5m g/d、培哚普利4m g/d共6个月,观察血压、左室结构和功能改变。结果:培哚普利联合氨氯地平治疗后,收缩压(SBP)和舒张压(DBP)明显降低(P<0.01);二尖瓣E/A峰速度比值明显升高;舒张末期左室内径(LVD d)、室间隔厚度(IV ST)、左室心肌重量(LVM)、左室后壁厚度(LVPW T)、左室心肌重量指数(LVM I)均显著下降。结论:培哚普利联合氨氯地平能有效地效降压,并同时逆转左室肥厚,改善左室舒张功能。     

培哚普利联合卡维地洛治疗高血压左心室肥厚

目的探讨培哚普利和卡维地洛联合应用逆转高血压左心室肥厚的效果。方法将156例高血压病(EH)合并左心室肥厚(LVH)患者随机分为培哚普利治疗组(77例,A组)和培哚普利 卡维地洛治疗组(79例,B组)。A组每日口服培哚普利2～8mg。B组每日口服培哚普利2～8mg和卡维地洛12.5～25mg。依血压高低增减剂量。两组患者均于入选前,治疗后12个月时,由二维超声心动图测定室间隔厚度(LVST)、左室后壁厚度(LVPWd)、左室舒张末期内径(LVDd)、计算左室心肌重量指数(LVMI)、左室射血分数(LVEF)、心排血量(CO),测二尖瓣舒张期血液A/E比值,进行统计分析。结果两组患者经12个月后的治疗,左心室肥厚程度均较治疗前减轻;LVMI、LVDd、LVST和LVPWd降低,差异均有显著性(P<0.05);两组A/E比值减小(P均<0.05);CO和LVEF无明显变化,B组LVMI、LVD、LVPW较A组下降更明显(P均<0.05),A/E比值B组亦较A组减小更显著(P<0.05)。结论培哚普利与培哚普利联合卡维地洛均可显著减轻高血压病患者的左心室肥厚程度,改善左室舒张动能;培哚善利联合卡维地洛较单独应用效果更佳。     

Effects of perindopril and hydrochlorothiazide on selected indices of oxidative stress in the blood of elderly patients with essential hypertension

1. The aim of the present study was to determine the effect of hypotensive therapy with a diuretic (hydrochlorothiazide) and an angiotensin-converting enzyme inhibitor (perindopril) on selected oxidative stress parameters in the blood of elderly patients with essential hypertension. 2. Studies were performed in 45 elderly patients with essential hypertension at baseline and after the 45th day of perindopril (n = 25) or hydrochlorothiazide (n = 20) therapy, as well as in 25 young and 25 elderly normotensive subjects. The following parameters were measured: systolic and diastolic blood pressure, nitric oxide (NO), carbonyl groups and malondialdehyde (MDA) concentrations, as well as the activity of ceruloplasmin (Cp) oxidase, Cu-Zn superoxide dismutase (SOD-1) and catalase (CAT). 3. The activity of SOD-1 and NO levels were reduced with age. 4. Compared with elderly controls, hypertensive subjects showed increases in baseline MDA, carbonyl group concentrations and Cp oxidase activity and decreases in NO levels and SOD-1 and CAT activities. 5. Treatment with perindopril, but not hydrochlorothiazide, resulted in significant increases in SOD-1 and CAT activities and decreases in MDA concentration and Cp oxidase activity. Both therapies decreased the level of carbonyl groups and increased NO levels. 6. Angiotensin-converting enzyme inhibitor therapy has significant anti-oxidant effects that may be important in the treatment of elderly patients with essential hypertension.     

Antioxidative effects of benidipine hydrochloride in patients with hypertension independent of antihypertensive effects. Relationship between blood pressure and oxidative stress

This study investigated the significance of measuring plasma level of thiobarbituric acid reactive substance (TBARS) in patients with hypertension and compared the clinical effects of benidipine hydrochloride (CAS 91599-74-5, Coniel) and amlodipine besylate (CAS 111470-99-6) on plasma TBARS. At first, blood pressure and plasma TBARS were measured in 85 untreated patients (48 males and 37 females, 68 years old on average) with at least one risk factor of cardiovascular disease to investigate factors which had influence on plasma TBARS. As the result, plasma TBARS was significantly higher in those with hypertension, which was also true when adjusted for other factors (r = 0.359, p< 0.01). Among these patients, benidipine hydrochloride at the dose of 4 mg/day was administered to 49 patients with hypertension or angina pectoris. All patients stratified for each factor showed significantly decreased plasma TBARS after benidipine hydrochloride treatment. Second, 40 untreated patients with essential hypertension were randomly assigned to the amlodipine group (5-7.5 mg/day) or benidipine group (4-8 mg/day) to compare the plasma TBARS levels. Plasma TBARS levels were significantly decreased in both groups. The amlodipine group showed a positive correlation between the decrease in plasma TBARS level and those in both diastolic and systolic blood pressures after treatment. On the other hand, benidipine hydrochloride decreased plasma TBARS to a greater degree than both diastolic and systolic blood pressures. These findings suggest that patients with hypertension have high plasma TBARS, and benidipine hydrochloride decreases not only blood pressure but also oxidative stress in the clinical practice.     

Clinical Experience with Perindopril in Elderly Hypertensive Patients

OBJECTIVE: To evaluate the effectiveness and safety of perindopril in a subgroup of 3010 elderly (> or =65 years) hypertensive patients, who participated in a large US general practice-based community trial. METHODS: All patients received open-label perindopril 4 mg once a day for 6 weeks. After 6 weeks the dosage was either maintained (group I) or increased to 8 mg/day (group II) based on the physician's assessment of blood pressure (BP) response. Patients were then followed for another 6 weeks for a total study duration of 12 weeks. RESULTS: Demographic and baseline clinical characteristics revealed a higher proportion of women, longer duration of hypertension and higher baseline systolic BP (SBP) among elderly than young (<65 years, n = 7332) hypertensive patients. A clinically relevant BP reduction of similar magnitude was obtained in elderly and young patients with perindopril monotherapy. At week 12, the mean reduction in BP from baseline was 18.4/8.7 mm Hg in the elderly and 17.5/11.3 mm Hg in the young. Elderly patients with hypertension not responding adequately to the 4 mg/day dosage at week 6 had a BP reduction of 6.3/3.6 mm Hg (group II). Up-titration to an 8 mg/day dosage for another 6 weeks gave an additional 8.9/3.5 mm Hg reduction resulting in a total reduction of 15.2/7.1 mm Hg from baseline. A similar magnitude of increase in response to up-titration of perindopril was seen in young patients. BP control (<140/90 mm Hg) on perindopril monotherapy was achieved in 41.4% of elderly and 51.9% of young patients. In both age groups, up-titration to an 8.0 mg/day dosage in group II patients increased BP control by approximately 5-fold at week 12 (28.2% in the elderly and 36.4% in the young). A similar increased response on BP reduction and BP control (<140/90 mm Hg) with up-titration was seen in elderly subgroups of African American and diabetic patients. The 7th Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure recommended target goal of <130/80 mm Hg was achieved with perindopril monotherapy in 15.6% of hypertensive diabetic patients. Perindopril reduced BP effectively and safely in very elderly (> or =75 years) hypertensive patients. Perindopril was well tolerated in elderly patients including high-risk groups. The incidence of cough (7-10%), the most common symptom, was similar in all age groups. The low incidence of postural hypotension (< or =0.2%) observed in the elderly and very elderly further supports the good tolerance and safety profile of the drug.Data analysis from this study suggests that community physicians, in general, are less aggressive in controlling BP in the elderly and more inclined to treat or control diastolic BP than SBP. CONCLUSION: Perindopril treatment is effective and well tolerated in elderly patients with hypertension.     

Effects of benidipine hydrochloride on autonomic nervous activity in hypertensive patients with high- and low-salt diets

The effects of benidipine hydrochloride (CAS 91559-74-5, Coniel) on autonomic nervous activity in hypertensive patients with high- and low-salt diets were investigated. Six patients having a urinary sodium excretion of 80 mEq/day or less (low salt group) and 6 patients having a urinary sodium excretion of 200 mEq/day or more (high salt group) were orally given benidipine hydrochloride (4 mg). Before and four weeks after the treatment with benidipine, 24-h circadian variation in blood pressure and 24-h Holter electrocardiogram (ECG) were recorded. The low frequency power spectrum of heart rate (LF power; 0.04-0.15 Hz), high frequency power spectrum of heart rate (HF power; 0.15-0.40 Hz), and the ratio of LF to HF (LF/HF) were calculated, and these parameters were averaged every hour in every subject. HF power was significantly lower and LF/HF ratio was significantly higher in the high-salt group than in the low-salt group before the treatment. However, the benidipine treatment significantly increased the HF power in both groups, particularly in the high-salt group, and significantly decreased the LF/HF ratio in both groups. Moreover, there was no significant difference in the antihypertensive effect of benidipine between the high- and low-salt intake groups. These results suggest that benidipine favourably influences blood pressure and autonomic nervous activity in hypertensive patients with a high-salt intake. It is concluded that benidipine may be useful for improving the development of salt-induced hypertension and its accompanying haemodynamic responses.     

Effects of benidipine hydrochloride on 24-hour blood pressure and blood pressure response to mental stress in elderly patients with essential hypertension

OBJECTIVE: The effects of a new dihydropyridine calcium antagonist, benidipine hydrochloride, on 24-hour blood pressure and blood pressure response to mental arithmetic test were investigated. SUBJECTS: Ten elderly patients with essential hypertension (mean age: 65+/-4 years; 7 male and 3 female). METHOD: After a control period of 4 weeks, 4 mg benidipine was administered once daily in the morning for 12 weeks. Ambulatory blood pressure was monitored using a non-invasive automatic portable device with the cuff-oscillometric method at the end of both the control and treatment periods. RESULTS: Benidipine administration significantly decreased 24-hour blood pressure, while little change was noted in heart rate. Daytime blood pressure decreased significantly, from 148.2+/-11.5/90.8+/-8.8 to 133.8+/-9.2/82.5+/-10.8 mmHg. However, no significant decrease in nighttime diastolic blood pressure was noted, and the decrease in nighttime systolic blood pressure was small (from 129.8+/-9.9/77.1+/-7.6 to 121.8+/-10.1/74.7+/-9.1 mmHg). No significant changes were observed in diurnal variability of blood pressure and heart rate. The decrease in systolic blood pressure by benidipine administration showed a significant positive correlation with systolic blood pressure before treatment in the 24-hour and daytime periods. Single cosinor analysis showed that benidipine administration significantly decreased MESOR of both systolic and diastolic blood pressure, without an increase in amplitude. Both systolic and diastolic blood pressure during mental arithmetic test were significantly decreased after treatment with benidipine, and the increase in systolic blood pressure induced by mental arithmetic test was also significantly attenuated. CONCLUSIONS: These findings indicate that administration of benidipine once daily in the morning effectively decreases blood pressure and attenuates blood pressure response to mental stress. Neither reflex tachycardia, deterioration of diurnal blood pressure change, nor excessive lowering of nighttime blood pressure was observed after benidipine administration. It is suggested that benidipine is a potent and long-lasting calcium antagonist which may be useful for the treatment of elderly hypertensive patients with cardiovascular disease.     

Antihypertensive efficacy and safety of benidipine and its effects on cardiac structure and function in elderly Chinese patients with mild to moderate hypertension: an open-label, long-term study

Benidipine (CAS 91599-74-5) has been reported as an effective antihypertensive treatment and its cardioprotective effects have been shown in several basic and clinical studies. However, the long-term efficacy and safety of benidipine remain unknown in elderly Chinese patient with hypertension. In this prospective, multicenter, open-label clinical trial, 152 eligible patients aged 60 to 75 years with mild to moderate essential hypertension (sitting systolic blood pressure (BP) > or = 140 mmHg and/or sitting diastolic BP > or = 90 mmHg) entered a 52-week study. All patients initially received benidipine 2-4 mg once a day, followed by titration to benidipine 8 mg/day to achieve the target BP (< 140/90 mmHg in non-diabetics and <130/80 mmHg in diabetics). Add-on hydrochlorothiazide (CAS 58-93-5) and/or metoprolol tartaric acid (CAS 3750-58-6) were permitted during the study. Overall, 132 patients completed the 52-week treatment with benidipine as monotherapy or combination therapy. It showed that the regimen based on benidipine provided an obvious mean trough BP reduction of 13.8 +/- 12.4/8.3 +/- 9.2 mmHg (p < 0.001), and 62.5% of patients reached the target BP. In patients with left ventricular hypertrophy, the left ventricular mass index significantly decreased from 147.1 +/- 27.6 g/m2 at baseline to 136.0 +/- 17.5 g/m2 at 52 weeks (p = 0.036). Clinical adverse events (AEs) were found in 15.1% of all patients, and six patients discontinued the treatment due to drug-related AEs during the entire trial. Patients' compliance was an average of 98.7%. Benidipine, with a favorable tolerability profile, provides a long-term antihypertensive effect and potential benefit for the heart in elderly patients with mild to moderate hypertensive, suggesting that it is suitable for elderly patients with hypertension.     

盐酸贝尼地平治疗原发性高血压的多中心临床研究

目的评价盐酸贝尼地平治疗原发性高血压病患者的疗效和安全性。方法用多中心随机单盲平行对照试验方法。贝尼地平(试验组)112例,氨氯地平(对照组)105例。结果治疗8周后,2组血压均有明显下降,与用药前比较差异均有统计学意义(P<0.001)。总有效率为贝尼地平77.68%,氨氯地平83.81%,2组间比较差异无统计学意义(P>0.05)。药物不良反应发生率为贝尼地平42.86%,氨氯地平41.60%,2组比较差异无统计学意义(P>0.05)。结论盐酸贝尼地平治疗原发性高血压安全、有效。     

Effects of benidipine, a long-lasting dihydropyridine-Ca2+ channel blocker, on cerebral blood flow autoregulation in spontaneously hypertensive rats

Chronic hypertension shifts cerebral blood flow (CBF) autoregulation towards higher blood pressure. We examined whether or not benidipine, a long-lasting dihydropyridine calcium channel blocker (CCB), improves the CBF autoregulation in spontaneously hypertensive rats (SHRs). CBF was analyzed by laser-Doppler flowmetry during stepwise hypotension by controlled bleeding. The lower limit of CBF autoregulation was calculated as the mean arterial blood pressure at which CBF decreased by 10% of the baseline. Mean arterial blood pressure and cerebral vascular resistance in SHRs were higher than those in normotensive Wistar rats. Oral administration of benidipine (3 mg/kg) for 8 d lowered the mean arterial blood pressure and cerebral vascular resistance, which were equivalent to the effects of amlodipine (3 mg/kg), another CCB, or candesartan (1 mg/kg), an Angiotensin II type-1 receptor blocker. The lower limit of CBF autoregulation in SHRs (142+/-4 mmHg) was significantly shifted to a higher-pressure level compared with Wistar rats (59+/-2 mmHg). The lower limit of CBF autoregulation was significantly lower in the benidipine-treated group (91+/-4 mmHg) than that in the control SHRs, and similar to that of the amlodipine group (97+/-6 mmHg). Benidipine reduced the lower limit of CBF autoregulation more effectively than candesartan (109+/-4 mmHg). In conclusion, benidipine shifted the limit of CBF autoregulation towards lower blood pressure in SHRs under hypotensive conditions by hemorrhage. These results suggest that benidipine may be useful for the treatment of hypertensive patients with the elderly or cerebrovascular disorders, in whom autoregulation of CBF is impaired.     

培哚普利联合伊贝沙坦治疗高血压病的临床观察

目的：观察培哚普利联合伊贝沙坦对高血压病患者血压、血肌酐、血钾、尿蛋白的影响。方法：将52例高血压病患者依数字随机法分为两组,各26例。对照组使用培哚普利降压,必要时加用吲达帕胺,观察组在此基础上加用伊贝沙坦,疗程均4周。检测两组治疗前后血压、24 h尿蛋白、血肌酐、血钾。结果：两组治疗前后组内比较,血压和24 h尿蛋白定量下降明显（P〈0.01）,血肌酐及血钾水平无明显改变（P〉0.05）。治疗后两组间血压比较差异不明显（P〉0.05）,观察组24 h尿蛋白定量较对照组下降明显（P〈0.01）。结论：培哚普利联合伊贝沙坦对降低高血压病患者尿蛋白排出量较单独应用培哚普利疗效更佳。