摘要
目的 探讨强化阿托伐他汀治疗对老年高血压患者血压变异性的影响.方法 入选河北省人民医院老年病科门诊就诊或住院的高血压病Ⅱ级以上的老年患者.所有入选患者随机分为标准治疗组（标准组,n =71）和强化治疗组（强化组,n =67）,两组均服用左旋氨氯地平2.5～5 mg,每日1次,或加贝那普利5～10 mg,每日1次,将患者的血压控制在140/90 mmHg（1 mmHg=0.133 kPa）以下.标准组加服阿托伐他汀20 mg 1次/晚,强化组应用阿托伐他汀40 mg 1/晚.入选时记录两组患者临床基线资料.治疗前和治疗后8周,测定高敏C反应蛋白（hs-CRP）和同型半胱氨酸（Hcy）水平,比较两组患者治疗前和治疗后8周肝肾功能和血脂水平变化.所有患者均于入选时和治疗后8周分别进行动态血压监测,记录和比较相关参数.结果 两组患者临床基线资料、基线血压和血压变异性差异均无统计学意义（P＞0.05）.经过8周治疗,标准组患者夜间SBP、晨峰SBP、白昼DBP、夜间DBP以及晨峰DBP均较治疗前明显下降（均P＜0.05）,强化组患者SBP、DBP以及晨峰血压水平均显著下降（均P＜0.05）,且强化组患者24 hSBP、白昼SBP、夜间SBP、白昼DBP和夜间DBP水平明显低于标准组（均P＜0.05）.经过8周治疗,标准组患者24 hSBPV、白昼SBPV、24 hDBPV、白昼DBPV较治疗前明显改善,强化组患者24 hSBPV、白昼SBPV、夜间SBPV、24 hDBPV、白昼DBPV较治疗前显著改善（均P＜0.05）.与标准组相比,强化组患者白昼SBPV和DBPV改善更加明显（均P ＜0.05）.治疗8周后,两组患者血清hs-CRP和Hcy水平均降低（均P＜0.05）,强化组hs-CRP水平下降更加明显（P ＜0.05）.两组患者治疗后均出现丙氨酸转氨酶和天冬氨酸转氨酶一定水平的升高,但是升高幅度无临床意义.结论 强化他汀治疗可以在一定程度上提高老年高血压患者降压效果,改善血压变异性.
Objective To investigate the effects of intensive treatment with atorvastatin on blood pressure variability in elderly patients with hypertension. Methods The elderly patients with grade 2 or 3 hypertension who were administered from in the Second Department of Geriatrics, Hebei Genaral Hospital were enrolled, and all the patients were divided into standard treatment group （standard group, n =71） and mtenswe treatment group （intensive groupt n = 67）. The patients in both groups were administered with levamlodipine besylate 2.5-5 mg to make the blood pressure below 140/90 mmHg. Patients in standard group were given atorvastatin 20 mg once each night, and patients in intensive group were given 40 mg once each night. The baseline data were recorded. The 24-hour dynamic blood pressure, blood pressure variability, levels of hs-CRP and Hcy, the functions of liver and kidney, as well as levels of blood lipid before and 8-week after treatment were compared between the two groups.Results The baseline data, baseline blood pressure and blood pressure variability between two groups were similar （all P 〉0.05）. After 8- weeks＇ treatment, the levels of night time SBP, morning SBP surge, day time DBP, night time DBP and morning DBP surge decreased in standard group（all P 〈0.05）. The levels of SBP, DBP and morning blood pressure surge decreased in intensive group. There were significant improvements in 24 h SBP （all P 〈0.05）, day time SBP, night time SBP （all P 〈0.05）, day time DBP and night time DBP in intensive group compared with those in standard group （all P 〈0.05）. There were significant improvements in the levels of 24 hSBPV, day time SBPV, 24 hDBPV, day time SBPV in standard group, as well as levels of 24 hSBPV, day time SBPV, night time SBPV, 24 hDBPV and day time DBPV in intensive group （all P 〈0.05）. The levels of day time SBPV and DBPV were lower in intensive group （both P 〈0.05）. After 8-weeks＇ treatment, the levels of hs-CRP and Hcy decreased in both groups （all P 〈0.05）, and the level of hs-CRP in intensive group was much lower （ P 〈 0.05）. Conclusion Intensive treatment with atorvastatin may improve the antihypertensive efficacy and blood pressure variability in elderly patients with hypertension.
出处
《临床荟萃》
CAS
2014年第12期1330-1333,共4页
Clinical Focus
关键词
高血压
血压变异性
他汀
强化治疗
老年人
hypertension
blood pressure variability
atorvastatin
intensive treatment
old patients
