氨氯地平联合复方阿米洛利或替米沙坦对高血压患者降压疗效的相关临床因素分析

目的：探讨以氨氯地平为基础的联合降压治疗方案不能有效控制高血压患者血压的相关临床影响因素。方法：2008年3月至10月在浙江省11家医疗机构入选50～79岁伴心血管病危险因素的高血压患者700例,采用多中心、随机、开放、对照的临床试验方法,随机分为氨氯地平加复方阿米洛利组（A组,354例）或氨氯地平加替米沙坦组（B组,346例）,进行早期联合药物降压治疗,随访观察8周。根据血压控制情况,A组中分为血压控制亚组（290例）和血压未控制亚组（64例）,B组中分为血压控制亚组（272例）和血压未控制亚组（74例）。结果：A、B两组高血压患者的血压控制率分别达81.9%和78.6%。A组中血压未控制亚组的基线收缩压、舒张压和体重指数（BMI）均显著高于血压控制亚组（P〈0.01）;心率、合并脑血管疾病史较高于血压控制亚组（P〈0.05）。B组中血压未控制亚组的血尿酸、蛋白尿均显著高于血压控制亚组（P〈0.01）;收缩压、舒张压较高于血压控制亚组（P〈0.05）。多因素Logistic逐步回归分析显示,BMI、心率和舒张压是氨氯地平加复方阿米洛利联合降压治疗血压未控制的危险因素（OR值分别为1.136、1.047和1.074）。尿酸、尿蛋白是氨氯地平加替米沙坦联合降压治疗血压未控制的危险因素（OR值分别为1.004和1.536）。结论：舒张压、心率和肥胖是氨氯地平联合复方阿米洛利降压疗效欠佳的主要相关临床因素。尿酸、蛋白尿是氨氯地平联合替米沙坦降压疗效欠佳的主要相关临床因素。

Effects of amlodipine-based combination amiroride or telmisartan antihypertensive therapy on blood pressure control in hypertensive patients

AIM：To evaluate the effect factors of amlodipine-based combination amiroride or telmisartan antihypertensive therapy on blood pressure uncontrol in hypertensive patients. METHODS：700 hypertensive patients from 11 centers in Zhejiang province from Mar.to Oct.2008 were included in this multi-centre randomized controlled clinical trial.Patients were randomly assigned to receive amlodipine plus amiroride（group A,n=354） or amlodipine plus telmisartan（group B,n=346）.All patients were followed-up for 8 weeks.RESULTS：Blood press control rates reach 81.9% and 78.6% in group A and group B,respectively.In group A,systolic blood pressure（SBP）,diastolic blood pressure（DBP） and body mass index（BMI） in blood pressure uncontrol patients were significantly higher than those in blood pressure control（P0.01）.Heart rate（HR） and cerebrovascular disease history in blood pressure uncontrol patients were higher than those in blood pressure control（P0.05）.In group B,urine acid and proteinuria in blood pressure uncontrol patients were significantly higher than those in blood pressure control（P0.01）.The levels of SBP and DBP were higher than those in blood pressure control（P0.05）.Results from multivariate logistic regression model showed that odds ratio of BMI,HR and DBP were 1.136,1.047,1.074,respectively in group A,the odds ratio of UA and proteinuria were 1.004,1.536,respectively in group B.CONCLUSION：DBP,HR and obesity are main clinical factors of blood pressure uncontrol in amlodipine plus amiroride,UA and proteinuria are main clinical factors of blood pressure uncontrol in amlodipine plus telmisartan.