摘要:
Objective To evaluate the efficacy of Nebivolol on patients with mild or moderate essential hypertension(EH) using different methods of ambulatory blood pressure monitoring.Methods Forty-seven patients with mild or moderate EH were enrolled as our subjects after a 2-week administration of placebo.They were administrated Nebivolol (5 mg) once daily for 12 weeks.All the patients completed ambulatory blood pressure monitoring before and after taking Nebivolol for 12 weeks.The overall and individual methods were used to calculate the trough-to-peak ratio (T/P ratio) and smooth index (SI).Results (1) For all of 42 patients treated with Nebivolol (5 mg) for 12 weeks,the systolic blood pressure(SBP),diastolic blood pressure(DBP) of the whole-day,daytime and nighttime after treatment were decreased compared to before treatment (the whole day:(144.1 ± 9.8),(124.4 ± 10.4) mmHg vs.(93.2 ± 6.3),(79.2 ± 7.2) mmHg;daytime:(148.9 ± 9.7),(128.3 ± 10.5) mmHg vs.(96.8 ±6.1),(82.2 ±7.5) mmHg;nighttime:(133.9 ± 11.9),(115.9 ± 12.0) mmHg vs.(85.7 ± 8.0),(72.5 ± 7.5) mmHg),and there was significant difference (t =8.06,8.74,8.00,8.82,5.75,and 6.57 respectively; P < 0.01).T/P ratios of SBP/DBP calculated by overall method were 78.4% (17.4/22.2) and 61.2% (9.0/14.7),but it were (79.3 ±0.4) % and (58.5 ±0.5) % by individual calculation method.(2) Among 30 patients with better effect,the SBP,DBP of the whole-day,daytime and nighttime after treatment were decreased compared to before treatment (the whole day:(143.4 ± 9.1),(127.5 ±10.7) mmHgvs.(92.6 ±6.2),(81.6±7.6) mmHg;daytime:(147.8 ±9.1),(131.0 ±10.5)mmHg vs.(95.8 ± 6.4),(84.1 ± 7.5) mmHg; nighttime:(134.7 ± 11.6),(119.6 ± 13.2) mmHg vs.(86.2 ± 7.4),(75.2 ± 8.5) mmHg),and there was significant difference(t =11.18,12.77,11.14,12.85,7.37,and 8.74 respectively,P <0.01).T/P ratios of SBP/DBP were 78.9% (18.3/23.2),75.3% (11.6/15.4) and SIof SBP/DBP were 7.4(19.5/2.6),7.1 (14.2/2.0) calculated by overall method,but T/P ratios of SBP/DBPwere (78.4 ± 0.4) %,(74.6 ± 0.4) % and SI were (1.35 ± 0.73),(1.34 ± 0.54) calculated by individualmethod.Conclusion Nebivolol (5 mg once daily) can significantly reduce ambulatory blood pressure.Overall calculation method is better than individual method in terms of assessing the time of durative action and smooth effect by trough peak ratio and smooth index.%目的 应用动态血压监测不同方法评价盐酸奈必洛尔治疗轻、中度原发性高血压(EH)的有效性.方法 经过2周安慰剂导入期,47例轻、中度EH受试者进入开放动态血压研究.受试者接受盐酸奈必洛尔片5 mg/d口服,共12周.清洗期末和12周治疗期末进行24 h动态血压测量,对可评估疗效受试者和治疗有效受试者应用整体法和个体法计算谷峰比值和平滑指数.结果 (1)可评估疗效的受试者42例,全天收缩压、舒张压分别为(144.1±9.8)、(124.4±10.4) mmHg,(93.2±6.3)、(79.2±7.2) mmHg;白天收缩压、舒张压分别为(148.9 ±9.7)、(128.3±10.5) mmHg,(96.8±6.1)、(82.2±7.5) mmHg;夜间收缩压、舒张压分别为(133.9±11.9)、(115.9±12.0) mmHg,(85.7±8.0)、(72.5±7.5) mmHg,治疗前后比较差异均有统计学意义(t值分别为8.06、8.74,8.00、8.82,5.75、6.57,P均<0.01);整体法计算收缩压、舒张压的谷峰比值为78.4%(17.4/22.2)、61.2% (9.0/14.7),个体法计算收缩压、舒张压的谷峰比值为(79.3±0.4)%、(58.5±0.5)%.(2)治疗有效的受试者30例,全天收缩压、舒张压分别为(143.4±9.1)、(127.5±10.7) mmHg,(92.6±6.2)、(81.6±7.6) mmHg;白天收缩压、舒张压分别为(147.8±9.1)、(131.0±10.5) mmHg,(95.8±6.4)、(84.1±7.5) mmHg;夜间收缩压、舒张压分别为(134.7±11.6)、(119.6±13.2) mmHg,(86.2±7.4)、(75.2±8.5) mmHg,治疗前后比较差异均有统计学意义(t值分别为11.18、12.77,11.14、12.85,7.37、8.74,P均<0.01);整体法计算收缩压、舒张压的谷峰比值为78.9%(18.3/23.2)、75.3% (11.6/15.4),收缩压、舒张压的平滑指数为7.4 (19.5/2.6)、7.1(14.2/2.0);个体法计算收缩压、舒张压的谷峰比值为(78.4±0.4)%、(74.6±0.4)%,收缩压、舒张压的平滑指数为1.35±0.73、1.34±0.54.结论 盐酸奈必洛尔5 mg每天1次服用能显著降低全天收缩压和舒张压.应用整体法计算治疗有效受试者的谷峰比值和平滑指数比个体法可更合理地评价药物降压作用的维持时间和平稳性.