睡前服用缬沙坦氢氯噻嗪对非杓型高血压患者动态动脉硬化指数及尿微量白蛋白的影响
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摘要
目的探讨不同时间应用缬沙坦氢氯噻嗪片对非杓型高血压患者动态动脉硬化指数(AASI)及尿微量白蛋白(MAU)的影响。方法纳入2015年6月至2017年3月就诊于河北省人民医院新诊断的80例1～2级非杓型高血压患者,采用随机化编码表法分为晨起服药组和睡前服药组各40例,分别在晨起或睡前服用缬沙坦氢氯噻嗪片(每片含缬沙坦80 mg及氢氯噻嗪12.5 mg),所有患者治疗前及治疗12周后进行动态血压监测并记录AASI值,检测MAU。AASI定义为1减去24 h舒张压(24 hMDBP)和收缩压(24 hMSBP)的回归系数。MAU定义为男性尿白蛋白/肌酐比≥22 mg/g,或者女性尿白蛋白/肌酐比≥31 mg/g。结果晨起服药组和睡前服药组患者治疗后24 hMSBP、24 hMDBP较治疗前均显著降低(P均<0.01),治疗后AASI、MAU较治疗前降低(P均<0.05);服药后两组间24 hMSBP、24 hMDBP差异无统计学意义(P均>0.05),治疗后睡前服药组AASI、MAU较晨起服药组降低(P均<0.05)。结论晨起或睡前服用缬沙坦氢氯噻嗪片均能明显降低非杓型原发性高血压患者的全天血压,改善AASI、MAU水平;不同时间服用缬沙坦氢氯噻嗪对24 hMSBP、24 hMDBP无影响,但睡前服药较晨起服药改善非杓型高血压患者的AASI、MAU水平更显著。
Objective To investigate the effect of valsartan hydrochlorothiazide adminsterd at different time on ambulatory arterial stiffness index(AASI) and microalbuminuia(MAU) in patients with non-dipper hypertension.Methods Eighty patients with grade 1-2 non-dipper hypertension were randomly divided into morning medication group(n=40) and bedtime medication group(n=40).Valsartan hydrochlorothiazide tablets(contain 80 mg valsartan and 12.5 mg hydrochlorothiazide) were taken in the morning or before bedtime,respectively.All patients were monitored by ambulatory blood pressure monitoring before treatment and 12 weeks after treatment.AASI values were recorded and MAU was detected.Results The mean systolic blood pressure(SBP),diastolic blood pressure(DBP),AASI and MAU in two groups after treatment were significantly lower than those before treatment(P<0.05,P<0.01).There was no significant difference in 24 hMSBP and 24 hMDBP between the two groups after taking medicine(all P>0.05).After treatment,AASI and MAU in the bedtime medication group were lower than those in the morning medication group(all P<0.05).Conclusions Taking valsartan hydrochlorothiazide tablets in the morning or before bedtime can significantly reduce the whole-day blood pressure,and improve AASI and MAU in patients with non-dipper hypertension.Taking valsartan hydrochlorothiazide at different time has no effect on the average SBP and DBP of 24 hours,but taking valsartan hydrochlorothiazide before bedtime significantly improve AASI and MAU in patients with non-dipper hypertension compared with taking valsartan hydrochlorothiazide in the morning.
Objective To investigate the effect of valsartan hydrochlorothiazide adminsterd at different time on ambulatory arterial stiffness index(AASI) and microalbuminuia(MAU) in patients with non-dipper hypertension.Methods Eighty patients with grade 1-2 non-dipper hypertension were randomly divided into morning medication group(n=40) and bedtime medication group(n=40).Valsartan hydrochlorothiazide tablets(contain 80 mg valsartan and 12.5 mg hydrochlorothiazide) were taken in the morning or before bedtime,respectively.All patients were monitored by ambulatory blood pressure monitoring before treatment and 12 weeks after treatment.AASI values were recorded and MAU was detected.Results The mean systolic blood pressure(SBP),diastolic blood pressure(DBP),AASI and MAU in two groups after treatment were significantly lower than those before treatment(P<0.05,P<0.01).There was no significant difference in 24 hMSBP and 24 hMDBP between the two groups after taking medicine(all P>0.05).After treatment,AASI and MAU in the bedtime medication group were lower than those in the morning medication group(all P<0.05).Conclusions Taking valsartan hydrochlorothiazide tablets in the morning or before bedtime can significantly reduce the whole-day blood pressure,and improve AASI and MAU in patients with non-dipper hypertension.Taking valsartan hydrochlorothiazide at different time has no effect on the average SBP and DBP of 24 hours,but taking valsartan hydrochlorothiazide before bedtime significantly improve AASI and MAU in patients with non-dipper hypertension compared with taking valsartan hydrochlorothiazide in the morning.
引文
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[10] 曹滢.动态动脉硬化指数与原发性高血压患者血压昼夜节律的相关性研究[J].实用心脑肺血管杂志,2017,25(6):14-18.
[11] Di Raimondo D,Casuccio A,Di LIberti R,et al.Relationship Between Ambulatory Arterial Stiffness Index (Aasi) And Night/Day Blood Pressure Ratio In Essential hypertensives[J].Curr Hypertens Rev,2017,13(2):121-131.
[12] 陈家林,庄义浩,蒋凌燕.原发性高血压患者微量白蛋白尿与心室肥厚的关系[J].河北医药,2015,37(12):1848-1849.
[13] Seo MH,Lee JY,Ryu S,et al.The Effects of Urinary Albumin and Hypertension on All-Cause and Cardiovascular Disease Mortality in Korea[J].Am J Hypertens,2017,30(8):799-807.
[14] Nah DY,Lee CG,Bae JH,et al.Subclinical renal insufficiency range of estimated glomerular filtration rate and microalbuminuria are independently associated with increased arterial stiffness in never treated hypertensives[J].Korean Circ J,2013,43(4):255-260.
[15] Hermida RC,Ayala DE,Smolensky MH,et al.Chronotherapy improves blood pressure control and reduces vascular risk in CKD[J].Nat Rev Nephrol,2013,9(6):358-368.
[16] Hermida RC,Ayala DE,Mojón A,et al.Sleep-Time Ambulatory BP Is an Independent Prognostic Marker of CKD[J].J Am Soc Nephrol,2017,28(9):2802-2811.
[17] Roush GC,Fapohunda J,Kostis JB.Evening dosing of antihypertensive therapy to reduce cardiovascular events:a third type of evidence based on a systematic review and meta-analysis of randomized trials[J].J Clin Hypertens,2014,16(8):561-568.
[18] Roush GC,Fagard RH,et al.Prognostic impact from clinic,daytime,and night-time systolic blood pressure in nine cohorts of 13,844 patients with hypertension[J].J Hypertens,2014,32(12):2332-2340.
[2] Yilmaz H,Cakmak M,Inan O,et al.Association of ambulatory arterial stiffness index with sEPCR in newly diagnosed hypertensive patients[J].Ren Fail,2015,37(9):1409-1413.
[3] 陈荟荷,孙燕淑,刘梅林.老年高血压患者动态动脉硬化指数与左心室质量指数的相关性[J].中华心血管病杂志,2016,44(9):750-52.
[4] Fabbian F,Smolensky MH,Tiseo R,et al.Dipper and non-dipper blood pressure 24-hour patterns:circadian rhythm-dependent physiologic and pathophysiologic mechanisms[J].Chronobiol Int,2013,30(1/2):17-30.
[5] Parati G,Stergiou G,O′Brien E,et al.European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring [J].J Hypertension,2014,32(7):1359-1366.
[6] Hermida RC,Ayala DE,Mojón A,et al.Blunted sleep-time relative blood pressure decline increases cardiovascular risk independent of blood pressure level--the "normotensive non-dipper" paradox[J].Chronobiol Int,2013,30(1/2):87-98.
[7] Verdecchia P,Angeli F,Mazzotta G,et al.Day-night dip and early-morning surge in blood pressure in hypertension:prognostic implications[J].Hypertension,2012,60(1):34-42.
[8] Hermida RC,Ayala DE,Mojón A,et al.Sleep-time ambulatory blood pressure as a novel therapeutic target for cardiovascular risk reduction[J].J Hum Hypertens,2014,28(10):567-574.
[9] Chen Y,Liu JH,Zhen Z,et al.Assessment of left ventricular function and peripheral vascular arterial stiffness in patients with dipper and non-dipper hypertension[J].J Investig Med,2018,66(2):319-324.
[10] 曹滢.动态动脉硬化指数与原发性高血压患者血压昼夜节律的相关性研究[J].实用心脑肺血管杂志,2017,25(6):14-18.
[11] Di Raimondo D,Casuccio A,Di LIberti R,et al.Relationship Between Ambulatory Arterial Stiffness Index (Aasi) And Night/Day Blood Pressure Ratio In Essential hypertensives[J].Curr Hypertens Rev,2017,13(2):121-131.
[12] 陈家林,庄义浩,蒋凌燕.原发性高血压患者微量白蛋白尿与心室肥厚的关系[J].河北医药,2015,37(12):1848-1849.
[13] Seo MH,Lee JY,Ryu S,et al.The Effects of Urinary Albumin and Hypertension on All-Cause and Cardiovascular Disease Mortality in Korea[J].Am J Hypertens,2017,30(8):799-807.
[14] Nah DY,Lee CG,Bae JH,et al.Subclinical renal insufficiency range of estimated glomerular filtration rate and microalbuminuria are independently associated with increased arterial stiffness in never treated hypertensives[J].Korean Circ J,2013,43(4):255-260.
[15] Hermida RC,Ayala DE,Smolensky MH,et al.Chronotherapy improves blood pressure control and reduces vascular risk in CKD[J].Nat Rev Nephrol,2013,9(6):358-368.
[16] Hermida RC,Ayala DE,Mojón A,et al.Sleep-Time Ambulatory BP Is an Independent Prognostic Marker of CKD[J].J Am Soc Nephrol,2017,28(9):2802-2811.
[17] Roush GC,Fapohunda J,Kostis JB.Evening dosing of antihypertensive therapy to reduce cardiovascular events:a third type of evidence based on a systematic review and meta-analysis of randomized trials[J].J Clin Hypertens,2014,16(8):561-568.
[18] Roush GC,Fagard RH,et al.Prognostic impact from clinic,daytime,and night-time systolic blood pressure in nine cohorts of 13,844 patients with hypertension[J].J Hypertens,2014,32(12):2332-2340.