氟哌噻吨美利曲辛片对白大衣高血压患者白大衣效应及血压昼夜节律的影响

摘要

Objective To investigate the effects of flupentixol and melitracen on white coat effect and blood pressure circadian rhythm in white coat hypertensive patients. Methods A total of 120 white coat hypertensive patients were enrolled in this prospective observational study. After scoring by Hamilton anxiety scale ( HAMA) ,77 patients whose HAMA score> 7 points were randomly divided into two groups by a random number:39 cases in therapy group were given flupentixol and melitracen,and 38 cases in control group were given placebo. Ambulatory blood pressure monitoring ( ABPM ) , clinic BP ( CBP ) , the value of white coat effect ( WCE) and blood pressure circadian rhythm of two groups were observed before and after treatment. Results ( 1 ) After treatment the day dynamic blood pressure dSBP, dDBP of therapy group slightly increased in therapy group (all P<0. 05) while the night time day dynamic blood pressure nSBP, nDBP slightly decreased ( all P <0. 05 ) . But 24 h dynamic blood pressure SBP, and DBP in this group showed no significant change ( both P>0. 05 ); ambulatory blood pressure in control group did not change significantly (all P>0. 05),the difference between the two groups was not statistically significant (all P>0. 05). ( 2 ) In therapy group, office CBP decreased significantly after treatment ( P < 0. 01 ) while no significant change was found in control group ( P>0. 05 ) . But there was significant difference between two groups (P<0. 01). In therapy group,WCE value decreased significantly after treatment (P<0. 01) while no significant change was found in control group (P>0. 05). There is significant difference between two groups (P<0. 01). (3)In therapy group,dipper circadian rhythm incidence decreased significantly after treatment (P=0. 006) while no significant change is seen in control group (P=1. 0). There was statistical difference between two groups (P=0. 031). Conclusions Flupentixol and melitracen reduce the value of WCE in white coat hypertensive patients with anxiety and improve circadian rhythm of blood pressure. Therefore it may be a better option for this type of patients.%目的：探讨氟哌噻吨美利曲辛片对白大衣高血压患者白大衣效应及血压昼夜节律的影响。方法前瞻性选取120例白大衣高血压患者，进行汉密尔顿焦虑量表（ HAMA）评分，HAMA总分＞7分者共77例，然后将其按随机数字表法分为两组：治疗组39例，使用氟哌噻吨美利曲辛片，对照组38例，使用安慰剂。比较两组治疗前后动态血压监测各指标、诊室血压（ CBP）值、白大衣效应（WCE）值、血压昼夜节律的变化。结果（1）治疗组治疗后白昼动态平均血压dSBP、dDBP略有上升（均为P＜0.05），夜间动态平均血压nSBP、nDBP略有下降（均为P＜0.05），24 h动态平均血压24 h SBP、24 h DBP无明显变化（均为P＞0.05），对照组动态血压各指标均无明显变化（均为P＞0.05），两组组间比较差异无统计学意义（均为P＞0.05）。（2）治疗组治疗后CBP较治疗前有明显下降（均为P＜0.01），对照组无明显变化（均为P＞0.05），两组组间比较有统计学意义（均为P＜0.01）。治疗组治疗后WCE值较治疗前均明显缩小（均为P＜0.01），对照组无明显变化（均为P＞0.05），两组组间比较差异有统计学意义（均为P＜0.01）。（3）治疗组患者治疗后杓型血压昼夜节律的发生率明显升高（P＝0.006），对照组无明显变化（P＝1.0），两组组间比较差异有统计学意义（P＝0.031）。结论氟哌噻吨美利曲辛片能明显降低伴有焦虑的白大衣高血压患者WCE值，改善血压昼夜节律，可作为此类患者的一种较好的用药选择。