氢氯噻嗪联合缬沙坦治疗老年高血压的临床研究

目的 探讨氢氯噻嗪联合缬沙坦治疗老年高血压的临床疗效。方法 2011年7月—2014年6月上海交通大学医学院附属新华医院收治的老年原发性高血压患者96例，随机分为对照组（48例）和治疗组（48例），对照组口服缬沙坦胶囊80 mg/d。治疗组口服氢氯噻嗪片12.5 mg/d，其他同对照组。两组均持续治疗2个月。治疗后，评价两组的临床疗效，同时比较两组治疗前后收缩压（SBP）、收缩压变异度（SBPV）、舒张压（DBP）、舒张压变异度（DBPV）、血压晨峰（MBPS）的控制率、一氧化氮、内皮素的变化。结果 治疗组和对照组的总有效率分别为97.92%、83.33%，两组比较差异有统计学意义（P<0.05）。治疗后，两组患者平均SBP、SBPV、DBP、DBPV、内皮素均较治疗前显著降低，一氧化氮水平显著升高，同组治疗前后差异有统计学意义（P<0.05），且治疗后治疗组这些观察指标的改善程度优于对照组，两组比较差异有统计学意义（P<0.05）。治疗组MBPS控制率为93.75%，对照组为81.25%，两组比较差异有统计学意义（P<0.05）。结论 氢氯噻嗪联合缬沙坦治疗老年高血压具有较好的临床疗效，可显著降低患者血压和血压昼夜变异度，可能与调节内皮一氧化氮和内皮素水平有关。

Clinical study on hydrochlorothiazide combined with valsartan in treatment of elderly hypertension

Objective To investigate the effect of hydrochlorothiazide combined with valsartan in the treatment of elderly hypertension. Methods Collecting 96 cases suffered from elderly hypertension from July 2011 to June 2014 in Xinhua Hospital Affiliated to School of Medicine of Shanghai Jiaotong University, which were randomly divided into treatment (48 cases) and control (48 cases) groups. The patients in the control group were po administered with Valsartan Capsule, 80 mg/d, while the patients in the treatment group were po administered with Hydrochlorothiazide Tablets, 12.5 mg/d, and other treatment was the same as the control group. The patients in the two groups were treated for 2 months. After the treatment, the treatment efficacy was evaluated, while SBP, SBPV, DBP, DBPV, control rate of MBPS, NO, and endothelin were compared between the two groups. Results The efficacies in the control and treatment groups were 97.92% and 83.33%, respectively, and there were differences between the two groups (P < 0.05). After the treatment, SBP, SBPV, DBP, DBPV, and endothelin in the two groups were significantly reduced, while NO were significantly increased, and the difference was statistically significant before and after the treatment in the same group (P < 0.05). And after the treatment, those observational indexes were improved better than those in the control group, and there was significant difference between the two groups (P < 0.05). The control rate of MBPS in the treatment group was 93.75%, and in the control group was 81.25%, and there was significant difference between the two groups (P < 0.05). Conclusion Hydrochlorothiazide combine with valsartan has a good clinical effect in the treatment of elderly hypertension, and can significantly reduce the blood pressure and circadian variation of blood pressure, which may be associated with regulating the level of NO and endothelin.