不同联合用药方案治疗老年单纯收缩期高血压的对照研究

不同联合用药方案治疗老年单纯收缩期高血压的对照研究

【摘要】 目的 比较两种不同抗高血压方案(常规降压药/小剂量常规降压药加硝酸酯类药)治疗老年单纯收缩期高血压(ISH)的降压疗效和安全性。方法 176例轻、中度老年ISH患者，随机分为联合组：给予卡托普利(25 mg)，氢氯噻嗪(12.5 mg)，单硝酸异山梨酯缓释片(40 mg)，晨顿服;常规组：给予卡托普利(25 mg，2次/d)，氢氯噻嗪(25 mg,1次/d)。比较两组治疗前后(8 w末)的降压疗效及生化指标变化。结果 联合组能显著降低收缩压与脉压，降压疗效联合组、常规组分别为93.18%、74.71%，两组比较差异有显著(P<0.05)。两组心率及生化指标与基线值比较差异不显著(P>0.05)。结论 联合组小剂量三药联用晨服一次，能有效降低轻中度老年ISH患者的血压，降压效果大于双倍剂量常规二药联用，对代谢无明显不良影响。

【关键词】 老年;单纯收缩期高血压; 抗高血压药物

Contrast study of different medication therapy for senile patients with isolated systolic hypertension

YUAN ZhangShun, YUAN Ke, WU ZhongSong, et al.

Department of Cardiology, the Affiliated Hospital of Huaihua Medical College, Huaihua 418000, Hunan, China

【Abstract】 Objective To compare the efficacy and safety of two treatments of antihypertension (general hypotensor and small dose of general hypotensor added with mononitrate) for senile patients with isolated systolic hypertension (ISH). Methods 176 cases with mildtomoderate ISH were divided into two groups randomly. All of the patients in the united group were given captopril 25 mg, hydrochlorothiazide 12.5 mg and isosorbide mononitrate 40 mg per day in the morning. And the patients in the normal group were given captopril 25 mg twice a day and hydrochlorothiazide 25 mg once a day. The course of the treatment was 8 weeks. Blood pressure and biochemical indicator before and after the medicine were measured.Results The effect on systolic pressure and diastolic pressure was obviously in the united group. And the general efficacy of the united group and the normal group were 93.18% and 74.71% separately, and there was obvious difference between the two groups (P<0.05). There was no obvious difference in heart rate and biochemical indicator between the two groups (P>0.05). Conclusions The therapy of small dose of captopril, isosorbide mononitrate and hydrochlorothiazide once in the morning can efficiently decrease the blood pressure of senile patients with mildtomoderate ISH. The therapeutic effect is doubled by double doses of captopril and hydrochlorothiazide, which has no bad effect on metabolism.

【Key words】 Aged people; Isolated systolic hypertension; Dyazide

老年单纯收缩期高血压(ISH)的发病机制与青年人不同，患者的外周血管阻力只有临界性的升高，主要是由于大动脉僵硬所导致〔1，2〕，而现有抗高血压药物主要针对降低周围血管阻力，因而在降低收缩压(SBP)的同时，容易使舒张压(DBP)过低，脉压(PP)增宽，从而造成新的心、脑血管事件危险性。目前认为，在降低大动脉僵硬度及相关心脏效应的药物中，利尿剂、硝酸酯类药物、肾素血管紧张素醛固酮系统(RAAS)抑制剂是最常用的〔3〕。为使此类患者克服常规降压药治疗抵抗，本研究主要针对老年ISH的发病机制，选择常规降压药与非常规降压药即卡托普利、氢氯噻嗪(HCTZ)与单硝酸异山梨酯(ISMN)缓释片，组成两种不同抗高血压方案，观察比较对轻、中度(1、2级)老年ISH的降压疗效和安全性，现将结果报道如下。

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