小剂量苯磺酸氨氯地平联用缬沙坦治疗单纯舒张期高血压的疗效观察

目的：探讨小剂量苯磺酸氨氯地平与缬沙坦联用治疗单纯舒张期高血压（IDH）的降压作用及对内生肌酐清除率（Ccr）的影响。方法：将本科62例初发单纯舒张期高血压患者随机分为2组，对照组30例仅予苯磺酸氨氯地平，治疗组32例联用缬沙坦，观察8周，比较2组治疗前后血压、内生肌酐清除率、心率、生化指标变化情况。结果：两组患者治疗前各指标基线特征无明显差异，治疗组降压作用总有效率达93％，对照组65％，治疗组舒张压治疗前（103．5±7．5）mmHg（1mmHg=0．133kPa）降至治疗后（82．6±5．8）mmHg；对照组治疗前（103．8±8．4）mmHg降至治疗后（88．1±5．4）mmHg，两组比较有统计学意义（P〈0．05），治疗组血清肌酐清除率由（65．2±15．1）升至（70．0±18．2）mL／（min·1．73m^2），升高6．8％，差异有统计学意义（P〈0．05）；对照组则无明显变化（65．8±14．6）比（66．3±15．2）mL／（min·1．73m^2）P=0．637]；治疗组提高Ccr的作用明显优于对照组，有统计学意义（P〈0．001）；两组患者出现不良反应轻微。结论：苯磺酸氨氯地平与缬沙坦联用治疗单纯舒张期高血压降压疗效好，不良反应小，并可提高血清肌酐清除率，改善肾功能。

Efficacy of small-dose amlodipine besylate plus valsartan in patients with isolated diastolic hypertension

Objective ：To investigate the effect of small-dose amlodipine besylate plus valsartan on blood pressure and calculated creatinine clearance in patients with isolated diastolic hypertension. Methods： Sixty-two patients with primary isolated diastolic hypertension were randomized into two groups to be treated with amlodipine besylate alone （ control group, n = 30 ） or amlodipine besylate plus valsartan （ treatment group, n = 32 ） for 8 weeks. Clinical blood pressure （ CBP）, calculated creatinine clearance （Ccr）, heart rate and biochemistry of these patients were examined before and after the treatment. Results： At baseline, clinical characteristics of the participants in the 2 groups were similar. The total rate of antihypertensive response in two groups was 93% in the treatment group vs 65% in the control group. The CBP was shown to reduce from 103.5 ± 7.5 mmHg at baseline to 82.6 ± 5.8 mmHg after 8 weeks in the treatment group, compared with 103.8± 8.4 mmHg to 88.1 ± 5.4 mmHg in the control group （ 1 mmHg = 0. 133 kPa） , with a significant difference between two groups （P 〈0. 05）. There was a significant 6.8% rise in calculated creatinine clearance in the treatment group from baseline （65.2± 15.1 ） to （70.0 ± 18.2 ） mL/ （ min · 1.73 m^2 ）, （P〈0. 05）], but not in the control group （65.8±14.6） to （66.3±15.2） mL/ （min · 1.73m^2）, P=0.637]. Patients in the treatment group received more benefits in terms of Cer elevated （P 〈 0.001 ）. Adverse effects appeared mild and comparable in the both groups. Conclusion： The combination therapy with small-dose amlodipine besylate plus valsartan may lower blood pressure effectively and safely in IDH patients, and increase the calculated ereatinine clearance to improve renal function.