摘要
目的探讨不同时间点联合使用培哚普利和硝苯地平对非杓型高血压患者的降压效果及肾功能的保护作用。方法依据服药时间，将105例原发性高血压患者分为A、B、C组，A组早晨顿服培哚普利片8mg和硝苯地平控释片30mg，B组早晨服用培哚普利片8mg、晚上硝苯地平控释片30mg，C组晚上顿服培哚普利片8mg和硝苯地平控释片30mg。治疗前和治疗8周后对患者进行24h动态血压监测（ABPM）和肾功能检测并进行比较。结果根据24hABPM结果剔除杓型、超杓型、反杓型高血压患者5例，治疗8周后失访7例，最终93例非杓型高血压患者完成研究，其中A组61例，B组15例，c组17例。3组患者基线肾功能及血压等比较，差异均无统计学意义（P〉0．05）。与治疗前比较，治疗8周后3组清晨、日间和夜间平均收缩压和舒张压、晨峰血压及尿白蛋白／肌酐（UACR）均下降，肾小球滤过率（GFR）升高，差异有统计学意义（P〈0．05）。3组治疗前后清晨、日间和夜间平均收缩压和舒张压、晨峰血压、GFR、UACR的变化幅度比较，差异均有统计学意义（P〈0．05），且A组上述指标的变化幅度均低于B组和C组（P〈0．05）。GFR和UACR的变化幅度与清晨、夜间收缩压及晨峰血压的变化幅度均呈正相关（P〈0．05）。结论根据时间治疗学指导非杓型高血压患者早晚分开服用或晚上顿服降压药更有利于控制清晨、晨峰和夜间血压，对肾脏更具有保护作用。
Objective To explore the effect of antihypertension and protection of renal function on patients with non-dipper hypertension by combined perindopril and nifedipine in different time. Methods A total of 105 patients with primary hypertension were divided into group A, B and C. Patients in group A took perindopril（8 mg） and nifedipine（30 rag） at draught in the morning. Patients in group B took perindopril （8 mg） in the morning and nifedipine（30 mg） at night. Patients in group C took perindopril（8 mg） and nifedipine（30 rng） at draught at night. Detections of 24 h ambulatory blood pressure monitoring（ABPM） and renal function were performed before treatment and 8 weeks after treatment. Results Five patients with dipper or extreme-dipper or reversed-dipper hypertension were excluded by results of 24h ABPM and 7 patients were lost to follow-up. Ninety-three patients with non-dipper hypertension completed the research with 61,15,17 patients in group A, B and C respectively. Ranal function and blood pressure at baseline between the three group were not significantly different （P 〉 0. 05）. Compared with before treatment,mean systolic and diastolic blood pressure in early morning and daytime and at night, morning peak blood pressure and urinary albumin ereatinine ratio（UACR） decreased, but glomerular filtration rate （GFR） increased significantly 8 weeks after treatment in group A, B and C （ P 〈 O. 05 ）. Range of variation of mean systolic and diastolic blood pressure in early morning and daytime and at night, morning peak blood pressure, UACR and GFR were significantly different in group A, B and C （P 〈 0. 05 ）. Range of variation of aboved indexes in group A were significantly lower than group B and C（P 〈0.05）. Range of variation of GFR and UACR were positively related with range of variation of systolic blood pressure in early morning and at night and morning peak blood pressure （P 〈 O. 05）. Conclusion It is more beneficial to control blood pressure in early morning, of morning peak and at night and protect renal function by taking antihypertensive drugs in the morning and at night resnectivelv or at draudat at night aecording to time theraneutics.
出处
《临床内科杂志》
CAS
2017年第10期673-676,共4页
Journal of Clinical Internal Medicine
基金
2014年武汉市卫生和计划生育委员会临床医学科研项目（WXl4812）
关键词
高血压
时间治疗学
晨峰血压
尿微量白蛋白/肌酐
肾小球滤过率
Hypertension
Time therapeutics
Morning peak blood pressure
Urinaryalbumin creatinine ratio
Glomerular filtration rate
