目的:观察左旋氨氯地平、替米沙坦联合氢氯噻嗪治疗反杓型高血压的疗效和安全性.方法:150例反杓型高血压患者随机分为A、B、C组,每组50例.A组患者给予替米沙坦片40 mg+氢氯噻嗪片10 mg,每日1次,清晨口服;B组患者给予左旋氨氯地平片5 mg,每日1次,晚间口服;C组患者给予替米沙坦片(用法用量同A组)+氢氯噻嗪片(用法用量同A组)+左旋氨氯地平片(用法用量同B组).3组疗程均为8周.观察并比较3组患者治疗前后电解质水平、24 h动态血压变化情况及治疗后反杓型节律逆转为正常杓型节律的逆转率,记录不良反应发生情况.结果:3组患者治疗前后电解质水平比较,差异均无统计学意义(P>0.05).治疗前,3组患者24 h血压比较,差异均无统计学意义(P>0.05);治疗后,3组患者24 h血压均显著低于同组治疗前,且C组均显著低于A组和B组,差异均有统计学意义(P0.05).结论:左旋氨氯地平、替米沙坦联合氢氯噻嗪分时服药治疗反杓型高血压不仅可以降低患者24 h血压,还能有效逆转反杓型节律,安全性亦较好.%OBJECTIVE:To investigate therapeutic efficacy and safety of levamlodipine and telmisartan combined with hydro-chlorothiazide in the treatment of anti-dipper hypertension. METHODS:Totally 150 patients with anti-dipper hypertension were ran-domly divided into group A,B,C,with 50 cases in each group. Group A was given Telmisartan tablet 40 mg+Hydrochlorothiazide tablet 10 mg,once a day,in the morning. Group B was given Levamlodipine tablet 5 mg,once a day,in the night. Group C was given Telmisartan tablet(usage and dosage same as group A)+Hydrochlorothiazide tablet(usage and dosage same as group A)+Le-vamlodipine tablet(usage and dosage same as group B). Treatment courses of 3 groups lasted for 8 weeks. The changes of electro-lyte and 24 h ambulatory blood pressure were observed and compared among 3 groups before and after treatment. The incidence of adverse reactions was recorded. RESULTS:There was no statistical significance in the electrolyte indexes in 3 groups before and af-ter treatment(P>0.05). Before treatment,there was no statistical significance in 24 h blood pressure among 3 groups(P>0.05). Af-ter treatment,the 24 h blood pressure of the patients in the 3 groups after treatment was lower than before treatment,and group C was lower than that of the group A and group B(P0.05). CONCLUSIONS:Levamlodipine and telmisartan combined with hydrochlorothiazide show good therapeutic efficacy for anti-dipper hypertension,and can reduce 24 h blood pressure and effectively reverse anti-dipper rhythm with good safety.
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