动态血压指导顽固性高血压患者调整服药时间的临床对照研究

目的 研究使用动态血压指导顽固性高血压患者调整用药时间治疗的达标情况.方法 将116例试验对象随机分为3组,分别为动态血压调整服药时间组（A组）、睡前服药组（B组）、晨起服药组（C组）,观察在调整用药前、治疗后4 w时对病人行动态血压监测（ABPM）的动态血压参数.结果 A组能够显著改善患者的24 h平均收缩压、24 h平均舒张压、24 h平均动脉压、日间平均收缩压、夜间平均收缩压、夜间平均舒张压、夜间平均动脉压和血压负荷.对服用起效时间≤4h的降压药患者,A组能够更加显著改善患者血压负荷（P＜0.01）;对于服用起效时间＞4 h的降压药或半衰期＞24 h的长效降压药患者,A、B组均优于C组.结论 顽固性高血压患者使用动态血压调整服药时间,能够显著提高患者的血压达标率.

A Case-Control Study of Ambulatory Blood Pressure to Guide Medication Time Adjustment for Patient with Resistant Hypertension

Objective To study blood pressure compliance status of patients with resistant hypertension to guide medication time adjustment by ambulatory blood pressure. Methods All 116 patients were randomly divided into ambulatory blood pressure group （group A）, bedtime medicine group （group B） and morning medicine group （group C）. Ambulatory blood pressure parameters were observed with ambulatory blood pressure monitoring （ABPM） before medication adjustment and four weeks after treatment. Results In group A, 24 h mean systolic blood pressure （24 h-MSBP）,24 h mean diastolic blood pressure （24 h-MDBP）,24 h mean arterial pressure （24 h- MAP）, daytime average systolic blood pressure （d-SBP）, night mean diastolic blood pressure （n-SBP）, night average diastolic blood pressure （n-DBP）, night mean arterial pressure （n-MAP） and blood pressure load of patients were significantly improved and blood pressure load of patients using antihypertensive drugs with the onset time less than 4 hours were significantly improved （P〈0. 01）. Patients using antihypertensive drugs （the onset time〉4 hours） or long-acting antihypertensive drugs （Half-life〉24 hours） in group A and group B are better than group C. Conclusion Medication time adjustment guided by ambulatory blood pressure can significantly improve blood pressure compliance status for patients with resistant hypertension.