左旋氨氯地平的时间药理学对纠正老年非杓型高血压的作用

目的按照时间治疗学的原则,探讨不同时间服用长效钙拮抗剂(CCB)左旋氨氯地平对老年非杓型高血压患者血压的影响。方法采用90217型无创动态血压监测仪,动态血压监测的方法筛选出54例入选前≥4周未使用二氢吡啶类CCB的老年非杓型高血压患者,随机分为左旋氨氯地平晨起服药组(n=28)和晚上服药组(n=26),2.5mg/d,共治疗48周。药物治疗前后分别进行诊室血压和动态血压监测的检查。结果1)不同时间服药组的诊室收缩压(SBP)在治疗后均明显降低(P<0.05),两组间的诊室SBP在治疗前后差异均无统计学意义(P>0.05)。2)动态血压结果显示,晨起服药及夜间服药均能降低夜间SBP(P<0.05,P<0.01),夜间服药更能有效地降低全天的SBP。3)晨起服药组的白天血压达标率(SBP<135mmHg)为39.3%,晚上服药组的白天血压达标率为30.8%,差异无统计学意义(P>0.05)。晨起服药组的夜间血压达标率(SBP<125mmHg)为28.6%,晚上服药组的夜间血压达标率为61.5%,差异有非常显著意义(P<0.01)。4)两组间纠正血压昼夜节律异常(由非杓型纠正为杓型)比例的差异有非常显著意义(晨起服药组17.9%比晚上服药组46.2%,P<0.01)。结论对于非杓型老年高血压患者,左旋氨氯地平在晚上服用时可以较好地纠正夜间的高负荷血压,提高夜间血压达标率。夜间及白天服用长效CCB均能有效地降低夜间血压。

The Pharmaco-Chronological Effects of Levo-amlodipine on Abnormal BP Circadian Rhythm in Hypertensive Patients in Elderly

Objective To investigate the pharmco-chronological effect of levo-amlodipine on BP and circadian rhythm in elderly hypertensive patients. Methods Fifty-five elderly patients with non-dipper pattern of night BP were treated with amlodipine (2.5 mg/d) with morning dose (n=28) and evening dose program(n=26) for 48 weeks. Results 1) Both programs decreased office SBP with no differences between them. ABPM showed that both programs effectively decreased night SBP, while evening program reduced night SBP more pronouncedly. Although the target day time SBP(<135 mm Hg) was of no differences between the 2 programs (39.3% vs 30.8%, P<0.05), the target night-time SBP(<125 mm Hg) was achieved by evening program in 61.5% patients which was greatly higher than that by morning program(28.6%, P<0.01). Circadian rhythm transformed from non-dipper to dipper was found in 17.9% in morning program versus 46.2% in the evening program(P<0.01). Conclusion Both morning and evening programs of levo-amlodipine administration were effective in decreasing night BP. Compared with morning program, evening program might be more effective in decreasing the high night BP load and alteration from non-dipper to dipper pattern.