缬沙坦联合氢氯噻嗪对中、重度高血压患者的临床疗效及安全性研究

目的 分析氢氯噻嗪结合缬沙坦在中、重度高血压病人治疗中的效果及安全性。方法 选取我院于2019年2月~2022年2月内收治的164例中、重度高血压病人，依据其治疗手段差异分成2组。观察组89例病人实施氢氯噻嗪结合缬沙坦口服治疗，对照组75例病人实施非洛地平结合缬沙坦口服治疗，持续治疗12周。对比两组患者治疗前后的动态血压监测结果，对比两组患者血液中一氧化氮、内皮素、血清钾离子水平，对比两组患者治疗前后的心脏彩超结果，以及对比两组患者的不良反应发生率情况。结果 经过治疗，两组患者平均24h的收缩压(24hSBP)、平均24h的舒张压(24hDBP)、白天平均收缩压(dMSBP)、白天平均舒张压(dMDBP)、夜间平均收缩压(nMSBP)、夜间平均舒张压(nMDBP)均下降，且观察组患者的各项血压水平均低于对照组（P＜0.05）。治疗后，两组病人的血清一氧化氮升高、内皮素降低，且观察组病人血清内的一氧化氮浓度水平较对照组高（P＜0.05），观察组病人的内皮素浓度水平较对照组病人低（P＜0.05）。两组患者的左心房容积指数、左心室后壁厚度(PWT)及左心室舒张期内径(LVEDD)均较治疗前下降(P＜0.05)，观察组患者的左心房容积指数、PWT及LVEDD低于对照组(P＜0.05)。观察组患者治疗前后的血清钾离子浓度变化无统计学意义（P＞0.05），对照组患者血清钾离子浓度提高，且浓度高于观察组患者（P＜0.05）。对照组患者高钾血症发生率高于观察组（P＜0.05），但总不良反应出现概率方面，两组病人对比并无差异（P＞0.05）。结论 缬沙坦联合氢氯噻嗪能有效降低中、重度高血压患者的血压水平，有效缓解患者的左心室肥大、改善患者的血管内皮功能，稳定患者的血钾水平且不增加不良反应发生率。

Clinical Efficacy and Safety of Valsartan Plus Hydrochlorothiazide in Patients with Moderate to Severe Hypertension

Objective To discuss the clinical efficacy and safety of valsartan plus hydrochlorothiazide in patients with moderate to severe hypertension. Methods One hundred and sixty-four patients with moderate to severe hypertension in our hospital from February 2019 to February 2022 were enrolled, and classified into 2 groups according to different treatment methods. Observation group (n=89) received oral valsartan combined with hydrochlorothiazide therapy, while control group (n=75) were given oral valsartan combined with felodipine. Then the blood pressure parameters, nitric oxide (NO) and endothelin-1 (ET-1), serum potassium ion concentration and adverse reaction rate were compared between 2 groups. Results The systolic blood pressure of 24-hour (24hSBP), diastolic blood pressure of 24-hour (24hDBP), mean systolic blood pressure of daytime (dMSBP), daytime mean diastolic blood pressure (n-DBP), mean systolic blood pressure of nighttime (nMSBP), and mean diastolic blood pressure of night (nMDBP) showed a decrease in both groups after treatment (P<0.05), and the above blood pressure parameters in observation group were all lower than control group after treatment (P<0.05). After treatment, an increase in nitric oxide and a reduction in endothelin-1 were observed in both groups (P<0.05), and observation group had higher nitric oxide and lower endothelin-1 levels than those of control group (P<0.05). Serum potassium ion concentration within observation group showed no significant changes before and after treatment (P>0.05), while the serum potassium ion concentration showed an increase in control group after treatment, and was higher than that of observation group (P<0.05). The left atrial volume index, posterior wall thickness (PWT), and LVEDD decrease in both groups after treatment (P<0.05), and the above 3 indicators of observation group were lower than control group (P<0.05). The incidence of hyperkalemia in control group was higher than observation group (P<0.05), but there was no statistical obvious in total adverse reaction rate between 2 groups (P>0.05). Conclusion Valsartan combined with hydrochlorothiazide in the treatment of moderate-to-severe hypertension can effectively reduce the blood pressure, relieve the left ventricular hypertrophy, improve the vascular endothelial function, stabilize the blood potassium level without increasing the incidence of adverse reactions.