硝酸酯类对老年单纯收缩期高血压患者脉压的影响

目的比较氨氯地平合用单硝酸异山梨酯缓释片与合用缬沙坦对老年单纯收缩期高血压（ISH）患者的疗效及对脉压（PP）的影响。方法将华师社区门诊单用氨氯地平血压控制仍不理想的56例老年ISH患者随机分成两组，治疗组（n=28）加用单硝酸异山梨酯缓释片（50mg／d），对照组（n=28）加用缬沙坦（80mg／d），疗程4周。比较两组收缩压（SBP）、舒张压（OBP）、脉压的变化。结果①两组SBP均明显下降（P〈0．01），2周后对照组SBP下降幅度略高于治疗组（P〈0．05），但4周后两组间下降幅度无明显差别（P〉0．05）；②治疗组DBP下降幅度小于对照组（P〈0．01）；PP明显缩小，与对照组比较差异有统计学意义（P〈0．01）。结论ISMN—SR在有效降低SBP的同时降低DBP不明显，使PP减小，有利于老年ISH患者的降压治疗。对于单用钙离子拮抗剂血压控制仍不理想的老年ISH患者加用硝酸酯类是比较理想的联合用药。

Influence of Nitrate Esters on Aged patients with Isolated Systolic Hypertension

Objective To compare the effect of combination of amlodipine and isosorbide mononitrate sustained release tablet （ISMN-SR） with the effect of combination of amlodipine and valsartan on elderly patients with isolated systolic hypertension （ISH）, and their influence on pulse pressure （PP）. Methods Fifty six elderly patients with ISH, whose blood pressure was controlled not very well with amlodipine alone,were randomly divided into two groups . The treatment group（n = 28） received amlodipine in combination with ISMN-SR（50 mg/d）, while the control group（ n = 28 ） were treated with amlodipine and valsartan（ 80 mg/d） for four weeks. Dynamic changes in systolic blood pressure （SBP）, diastolic blood pressure （DBP） and PP were determined. Results ①SBP were significantly decreased in both groups （ P 〈 0.01 ） ; after two weeks of treatment, the magnitude of reduction in SBP was greater in control group than that in treatment group（P 〈 0.05 ）, but it was resemble after four weeks later （ P 〉 0.05 ）. ②The magnitude of reduction in DBP of control group was less than that of control group （ P 〈 0.01 ）. The greater reduction in SBP and less reduction in DBP resulted in significant decreases in pulse pressure in treatment group（ P 〈 0.01 ）. Conclusions ISMN-SR can decrease SBP in ISH and has less effect on DBP,leading to decreasing in PP which is beneficial to ISH. CalCium in combination with ISMN-SR is ideal combination to the elderly patients with ISH.