不同降压药物联合治疗对老年高血压患者血压变异性的影响

目的探讨培哚普利联合氨氯地平或氢氯噻嗪对老年高血压患者血压变异性的影响。方法选取2018年1月-2019年1月于北京市某医院收治的80例老年高血压患者为研究对象,采用随机数字表法分为对照组与研究组,每组40例。对照组患者采用培哚普利联合氢氯噻嗪口服治疗,研究组患者采用培哚普利联合氨氯地平口服治疗,2组患者均治疗8周。比较治疗前后2组患者的白天平均收缩压(dSBP)、夜间平均收缩压(nSBP)、24 h平均收缩压(24 h SBP)、24 h平均收缩压变异系数(24 h SCV)、白天平均收缩压变异系数(dSCV)、夜间平均收缩压变异系数(nSCV),白天平均舒张压(dDBP)、夜间平均舒张压(nDBP)、24 h平均舒张压(24 h DBP)、24 h平均舒张压变异系数(24 h DCV)、白天平均舒张压变异系数(dDCV)、夜间平均舒张压变异系数(nDCV),血管内皮功能相关指标内皮素(ET)、一氧化氮(NO)、一氧化氮合成酶(eNOS)、颈动脉内膜中层厚度(IMT)、反应性充血后血管内径变化率(FMD)]变化,同时比较2组患者的不良反应、并发症发生情况。结果治疗前,2组患者24 h SBP,dSBP,nSBP,24 h SCV,dSCV及nSCV比较,差异均无统计学意义(P>0.05);治疗后,2组患者24 h SBP,dSBP,nSBP,24 h SCV,dSCV及nSCV均低于治疗前,且研究组明显低于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者24 h DBP,dDBP,nDBP,24 h DCV,dDCV及nDCV比较,差异均无统计学意义(P>0.05);治疗后,2组患者24 h DBP,dDBP,nDBP,24 h DCV,dDCV及nDCV均低于治疗前,且研究组24 h DCV,dDCV,nDCV明显低于对照组,差异均有统计学意义(P<0.05);治疗前,2组患者ET,NO,eNOS,IMT及FMD水平比较,差异均无统计学意义(P>0.05);治疗后,2组患者ET、IMT水平低于治疗前,且研究组明显低于对照组,差异均有统计学意义(P<0.05);2组患者NO,eNOS及FMD水平高于治疗前,且研究组明显高于对照组,差异均有统计学意义(P<0.05);2组患者治疗期间均未发生药物不良反应及严重并发症。结论培哚普利联合氨氯地平或培哚普利联合氢氯噻嗪均可有效治疗老年高血压,能够安全、有效地控制患者的血压水平、降低老年高血压患者的血压变异性,但培哚普利联合氨氯地平的治疗疗效更为理想。临床可根据患者实际病情,选择恰当的药物治疗方案,提升老年高血压治疗的有效性、安全性。

Effect of combination therapies of different antihypertensive drugs on the blood pressure variability in elderly patients with hypertension

Objective To investigate the effect of perindopril combined with amlodipine and perindopril combined with hydrochlorothiazide on blood pressure variability in elderly patients with hypertension.Methods A total of 80 elderly patients with hypertension who were admitted to a hospital in Beijing from January 2018 to January 2019 were selected as the research subjects.The patients were divided into a control group and a study group using a random number table,with 40 patients in each group.Patients in the control group were treated with perindopril combnined with hydrochlorothiazide,and patients in the study group were treated with perindopril combined with amlodipine.Both groups were treated for 8 weeks.The daytime systolic blood pressure(dSBP),nighttime systolic blood pressure(nSBP),24 h systolic blood pressure(24 h SBP),coefficient of variation of 24 h systolic blood pressure(24 h SCV),coefficient of variation of daytime systolic blood pressure(dSCV),coefficient of variation of nighttime systolic blood pressure(nSCV),daytime diastolic blood pressure(dDBP),nighttime diastolic blood pressure(nDBP),24 h diastolic blood pressure(24 h DBP),coefficient of variation of 24 h diastolic blood pressure(24 h DCV),coefficient of variation of daytime diastolic blood pressure(dDCV),coeffitient of variation of nighttime diastolic blood pressure(nDCV),and changes in relevant endothelial function indices including endothelin(ET),nitric oxide(NO),endothelial nitric oxide synthase(eNOS),carotid intima-media thickness(IMT)and flow-mediated diamete(FMD)before and after treatment were compared.The adverse reactions and complications of the two groups were compared.Results Before treatment,there was no significant difference in 24 h SBP,dSBP,nSBP,24 h SCV,dSCV,and nSCV between the two groups(P>0.05).After treatment,the 24 h SBP,dSBP,nSBP,24 h SCV,dSCV,and nSCV of the two groups were lower than before treatment,and those of the study group were significantly lower than those of the the control group(P<0.05).Before treatment,there was no significant difference in 24 h DBP,dDBP,nDBP,24 h DCV,dDCV,and nDCV between the two groups(P>0.05).After treatment,the 24 h DBP,dDBP,nDBP,24 h DCV,dDCV,and nDCV of the two groups were lower than before treatment,and the 24 h DCV,dDCV,and nDCV of the study group were significantly lower than those of the control group(P<0.05).Before treatment,there was no significant difference in the levels of ET,NO,eNOS,IMT,and FMD between the two groups(P>0.05).After treatment,the levels of ET and IMT of the two groups were lower than before treatment,and those of the study group were significantly lower than those of the control group(P<0.05);the levels of NO,eNOS,and FMD of the two groups were higher than before treatment,and those of the study group were significantly higher than those of the control group(P<0.05).No adverse drug reactions or serious complications was observed during treatment.Conclusion Perindopril combined with amlodipine and perindopril combined with hydrochlorothiazide can effectively treat hypertension in the elderly.Both therapies can safely and effectively control the blood pressure level of patients and reduce blood pressure variability,while perindopril combined with amlodipine is more effective.According to the actual condition of the patient,appropriate drug treatment options can be selected to improve the effectiveness and safety of clinical treatment of hypertension in the elderly.