氢氯噻嗪联合盐酸贝那普利对非杓型高血压患者血压水平的影响

目的按照时间治疗学原则,探讨不同时间服用氢氯噻嗪和盐酸贝那普利对新发1级、2级非杓型高血压患者血压水平的影响。方法对62例非杓型高血压患者随机分为早氢氯噻嗪＋早盐酸贝那普利组（早早组）和早氢氯噻嗪＋晚盐酸贝那普利组（早晚组）,共治疗8周。服药前后进行诊室血压测量和动态血压监测,观察药物对血压水平及血压昼夜节律的影响。结果治疗后两组诊室收缩压（SBP）和舒张压（DBP）均较治疗前明显下降（P〈0.05）;两组间诊室SBP和DBP在治疗前后差异无统计学意义。动态血压结果显示,两组患者的24 hSBP和24 hDBP水平均较治疗前有明显下降（P〈0.01）。早晚组患者的夜间SBP和DBP达标率明显高于早早组（P〈0.01）。在血压昼夜节律纠正方面,早早组将非杓型纠正为杓型血压的比例为20%,早晚组将非杓型纠正为杓型的比例为40%（P〈0.01）。结论对于新发1级和2级非杓型高血压患者,联合服用氢氯噻嗪和盐酸贝那普利可以有效控制血压。晚上服用盐酸贝那普利可以较好地纠正夜间的高负荷血压,维持正常的昼夜变化节律。

The Pharmacological Effects of Combination Therapy of Hydrochlorothiazide and Benazepril On Abnormal Blood Pressure Circadian Rhythm in Newly-onset Hypertension

Objective To investigate the pharmcochronological effect of combination therapy of hydrochlorothiazide and benazepril on blood pressure（BP）and circadian rhythm in patients with newly-onset,grade A and B hypertension.Methods Sixty two patients with non-dipper pattern of night BP were treated with combination of hydrochlorothiazide（morning dose） and benazepril（morning dose or evening dose）for 8 weeks.Results Both programs decreased office systolic blood pressure（SBP） and diastolic blood pressure（DBP） with no differences between them.The ambulatory blood pressure monitoring（ABPM） showed that both programs decreased 24 h SBP and 24 h DBP pronouncedly.The target nighttime SBP（125 mmHg）and DBP（75 mmHg） was achieved by evening program which was greatly higher than that by morning program.Circadian rhythm transformed from non-dipper to dipper was found in 20% in morning program versus 40% in the evening program（P0.01）.Conclusion The combination therapy of hydrochlorothiazide and benazepril was effective in decreasing blood pressure in patients with newly-onset,grade A and B,non-dipper hypertension.Compared with morning program,evening program of benazepril might be more effective in decreasing the high night BP load and alteration from non-dipper to dipper pattern.