硝苯地平控释片联合氯沙坦钾氢氯噻嗪治疗老年顽固性单纯收缩期高血压临床疗效及安全性

摘要

目的：评价硝苯地平控释片与氯沙坦钾氢氯噻嗪联合应用治疗老年顽固性收缩期高血压临床疗效、安全性。方法入选2014年1月～2015年1月于武警甘肃总队医院内三科收治的老年顽固性单纯收缩期高血压患者120例，其中男性84例，女性36例，年龄60～84岁，平均（67.3±6.0）岁。依据入院顺序采用随机队列插入法，将患者分为A组、B组、C组，每组40例。A组口服氯沙坦钾氢氯噻嗪片，B组口服硝苯地平控释片，C组氯沙坦钾氢氯噻嗪片联合硝苯地平控释片治疗。连续用药3个月。治疗前后检测收缩压（SBP）、舒张压（DBP）、肾小球滤过率（eGFR）、血清胱抑素C（Cys C）、尿微量白蛋白（mALB）、记录不良反应发生例数和评估疗效。结果3组患者通过年龄、性别、病程、合并症、体质指数等指标比较，差异无统计学意义（P均＞0.05）。在整个研究中有7例失去联系，获得A组38例、B组38例、C组37例的数据。C组显效率高于A组和B组，差异有统计学意义（P均＜0.05）。C组总有效率高于A组和B组，数值为（92.1%vs.73.7%）、（92.1%vs.78.9%），差异有统计学意义（P均＜0.05）。三组治疗后较治疗前血压下降，eGFR升高，差异有统计学意义（P均＜0.05）。与A组治疗后比较，B组SBP和eGFR下降，CysC、mALB升高，差异有统计学意义（P均＜0.05）。C组治疗后较A组和B组血压下降，eGFR升高，差异有统计学意义（P均＜0.05）。3组不良反应发生率差异无统计学意义（P均＞0.05）。结论硝苯地平控释片联合氯沙坦钾氢氯噻嗪治疗老年顽固性单纯收缩期高血压较单药治疗，疗效显著、安全可靠。%Objective To review the curative effect and safety of nifedipine controlled release tablets combining losartan potassium hydrochlorothiazide tablets on senile refractory isolated systolic hypertension (ISH).Methods The patients with senile refractory ISH (n=120, male 84, female 36, aged from 60 to 84, and average age=67.3±6.0) were chosen from Jan. 2014 to Jan. 2015. All patients were randomly divided into group A (given orally losartan potassium hydrochlorothiazide tablets), group B (given orally nifedipine controlled release tablets) and group C (given orally nifedipine controlled release tablets combining losartan potassium hydrochlorothiazide tablets, eachn=40). After continuous treatment for 3 m, the levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), glomerular filtration rate (GFR), serum cystatin C (Cys C) and urinary micro albuminuria (U-mAlb) were detected, cases of reverse reactions were recorded and curative effect was reviewed before and after treatment.Results There was no statistical significance in difference of age, gender, disease course, complication and body indexes among 3 groups (allP>0.05). There were 7 cases missed during the whole study, so the data was get from 38 cases in group A, 38 in group B and 37 in group C. The obvious effective rate was higher in group C than that in group A or group B (allP<0.05). The total effective rate was higher in group C than that in group A (92.1%vs. 73.7%) or group B (92.1%vs. 78.9%, allP<0.05). After treatment, blood pressure decreased and GFR increased in 3 groups (allP<0.05). After treatment, SBP and GFR decreased, and CysC and U-mAlb increased in group B compared with group A (allP<0.05). After treatment, blood pressure decreased and GFR increased in group A compared with group A and group B (allP<0.05). The difference in incidence of adverse reactions had no statistical significance among 3 groups (allP>0.05).Conclusion The therapy of nifedipine controlled release tablets combining losartan potassium hydrochlorothiazide tablets has significant curative effect and is safe and reliable in treatment of senile refractory ISH.