王磊 魏新伟 于芳

[摘要] 目的 探讨缬沙坦联合氨氯地平或氢氯噻嗪治疗老年高血压的疗效和安全性。 方法 整群选取2012年11月—2013年11月收治的老年高血压患者75例，随机分为两组，分别给予缬沙坦联合氨氯地平（氨氯地平组，n=36）或缬沙坦联合氢氯噻嗪（氢氯噻嗪组，n=31）降压治疗，治疗前、后监测两组24 h动态血压，比较两种方案对血压的影响。结果 两组治疗12周的24 h平均收缩压（SBP）、白昼SBP、夜间SBP、24 h 收缩压变异性（SBPV）、白昼SBPV均较治疗前降低（P<0.05）。治疗12周后氨氯地平组的24 h SBP、白昼SBP和夜间SBP均显著低于氢氯噻嗪组（P<0.05）。治疗12周后氨氯地平组的24 h SBPV及白昼SBPV均显著低于氢氯噻嗪组（P<0.01）。两组血压达标率和不良反应发生率差异均无统计学意义。 结论 缬沙坦联合氨氯地平或氢氯噻嗪能有效控制老年人高血压，而缬沙坦联合氨氯地平更适合老年高血压患者。

[关键词] 高血压；药物联合治疗；老年人；血压变异性

[中图分类号] R544.1 [文献标识码] A [文章编号] 1674-0742（2016）02（a）-0042-03

Clinical Efficacy and Safety of Two Antihypertensive Drugs in Combination in the Treatment of Elderly Patients with Hypertension

WANG Lei1， WEI Xin-wei1， YU Fang2

1. Department of Cardiology， The Peoples Hospital of Anyang City， Anyang， Henan Province， 455000 China；

2. Department of Nephrology， The Peoples Hospital of Anyang City， Anyang， Henan Province， 455000 China

[Abstract] Objective To observe the efficacy and safety of valsartan combined with amlodipine or hydrochlorothiazide regimen in the treatment of elderly hypertensive patients. Methods 75 elderly patients with hypertension admitted from November 2012 to November 2013 were randomized into two groups， the amlodipine group （n=36） treated by valsartan and amlodipine， and the hydrochlorothiazide group （n=31） treated by valsartan and hydrochlorothiazide. 24-hour dynamic blood pressure was monitored at baseline and after the antihypertensive treatment. The effect of treatment on the blood pressure was compared between the two groups. Results The mean 24 h systolic blood pressure （SBP）， daytime SBP， nighttime SBP and 24 h systolic blood pressure variability （SBPV）， daytime SBPV were lower at 12 weeks of treatment than baseline in both groups （P<0.05）. After 12 weeks of treatment， the 24 h SBP， daytime SBP and nighttime SBP were lower in the amlodipine group than in the hydrochlorothiazide group （P<0.05）. After 12 weeks of treatment， the 24 h SBPV and daytime SPBV were lower in the amlodipine group than in the hydrochlorothiazide group （P<0.01）. There was no significant difference in the control rate of blood pressure and incidence of side effects between the two groups. Conclusion Both valsartan in combination with amlodipine or hydrochlorothiazide can effectively lower the blood pressure in elderly hypertensive patients， but the former regimen is more suitable for elderly hypertensive patients.

[Key words] Hypertension； Combination drug therapy； The elderly； Blood pressure variability

我国已步入老龄社会，新近公布的第3次全国人口普查数据显示，≥65岁人口占8.87%。随着人口老龄化的进展，我国老年人群高血压的患病率将增加[1]，这在一定程度上也增加了老年高血压患者的冠心病、脑卒中和肾衰竭等多种并发症[2]，对老年患者的治疗和预后带来严重影响。对老年高血压患者而言，选择安全、有效、平稳降压、波动性小的药物尤为重要。目前，药物联合治疗老年高血压的相关研究并不少见，但最优降压方案仍存在争议。该研究通过分析近2012年11月—2013年11月间收住该院心内科的75例老年高血压患者，旨在比较缬沙坦联合氨氯地平或氢氯噻嗪在老年高血压人群中的疗效和安全性，进一步优化临床联合用药方案，现报道如下。

1 资料与方法

1.1 一般资料

整群选取于该院心内科诊治的老年高血压患者75例。75例患者依随机数字表法均分为两组，按方案完成并纳入分析的样本数为67例。……