氯沙坦对高血压病人24小时血压的影响

目的观察氯沙坦对高血压病人24小时血压的影响,探讨其临床意义。 方法20例Ⅰ-Ⅱ级高血压病人,入院后停药2周,服氯沙坦50mg，qd，疗程12周，1个月后血压若未降至140/90mmHg以下，可加大剂量到100mg，qd，治疗前后复查24小时动态血压。以二次给药间距终末时血压下降数除以给药间距中最大血压下降数值作为药物降压的谷/峰比(T∶P),以夜间血压均值与白昼血压均值比较时下降10%或大于10mmHg者为夜间血压下降或"杓型者",反之为夜间血压不下降者或"非杓型者"。 结果　发现(1)氯沙坦能明显降低高血压病人的24小时平均血压(mmHg)(SBP134±14比113±8,DBP89±12比71±5,P<0.01);有效率为85.0%.(2)氯沙坦降压的SBP和DBPTP比率分别为78.6%(48%～93.9%)和76.2%(46.4%～89.6%).SBP,DBP和MBP的平滑曲线指数分别是1.23±0.32,1.36±0.41和1.32±0.38.(3)对夜间血压高于正常值(120/80mmHg)的高血压患者,氯沙坦明显降低夜间血压(mmHg)(SBP142.6±8.8降至116.3±11.4,DBP89.2±9.6降至74.3±6.8,P<0.01),对夜间血压已属正常者,氯沙坦无进一步降压作用(SBP120.3±3.7比116.3±6.8;DBP78.2±6.1比74.3±7.2,P>0.05).(3)24小时SBP,DBP下降幅度与治疗前SBP,DBP明显相关,r分别为0.803和0.797,P<0.01. 结论　氯沙坦是一种安全有效的降压药,其主要优点是24小时平稳降压,谷峰比满意,夜间无过度降压的危险,晨间血压上升受到明显抑制,基础血压越高,降压效果越好。

Effect of Losartan on Ambulatory Blood Pressure in Hypertensives

Objective To investigate the effect of losartan on ambulatory blood pressure(ABP) in hypertensives. Method 20 cases essential hypertension(EH) were treated with losart an(50mg qd,at 7:00am) for 24 weeks. The ABP measured before and after treatment . The BP decreased at the end of the dose interval(trough) to the most large BP descr eased in the dose interval(peak) served as the ratio of trough∶peak(T∶P) of the drugs. Results (1)Losartan had hypotensive effect with the efficacy of 85. 0%. (2)T∶P ratio of losartan was 78.6±15.4 for SBP and 76.2±14.7 for DBP. Smoothness index of SBP, DBP and MBP was 1.23±0.32,1.36±0.41 and 1.32±0.38, respectively.(3)In hypertensives with nighttime BP higher than normal(>120/80 mmHg). Losartan was significantly decreased nighttime BP(SBP from 143±9 to 116±11 mmHg,P< 0.01,DBP from 89±10 to 74±7mmHg,P<0.01). In hypertensives with normal nighttime BP,losartan didn't decrease BP further(P>0.05).(4)The 24 h average decreased extent of SBP and DBP after treatment was positively correlated to SBP and DBP before treatmen t (r=0.803 and 0.797,respectively, P<0.01). Conclusion The main advantage of losartan is to decrease steadily 2 4 h BP and inhibit the elevation of morning BP significantly, no danger of exces sive decrease of BP in nighttime.