左旋氨氯地平治疗原发性轻中度高血压的临床疗效观察
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摘要
目的 观察左旋氨氯地平治疗原发性轻中度高血压的降压疗效，对运动中血压的影响以及不良反应。
方法 采用自身用药前后对照方法。根据WHO高血压的诊断标准收集入选患者：选取轻中度高血压患者40例，试验前未服用降压药物或停用其它降压药物1周以上，给予口服左旋氨氯地平2.5mg/d，早餐后服用，连续用药4周，每周复查一次，观察其诊所血压（CBP）、心率、不良反应。如降压疗较差，加量至5mg/d。所有患者于药物治疗前和治疗4周后进行动态血压监测和6分钟步行运动。
结果 40例（男19例）患者均完成试验。①诊所血压结果：治疗4周后平均收缩压（SBP）和舒张压（DBP）分别下降（21.70±9.34）mmHg与（13.50±7.83）mmHg，与治疗前相比有统计学意义（P<0.05）。诊所总有效率为90％。②动态血压监测结果：治疗4周后24h SBP与24h DBP分别下降（16.14±9.94）mmHg与（9.02±8.14）mmHg，与治疗前相比有统计学意义（P<0.05）。治疗4周后白昼夜间SBP、DBP负荷值和夜间血压下降率与治疗前相比明显下降（P<0.05）。24hABMP总有效率为85％。③运动试验结果：治疗4周后运动后即刻SBP和DBP分别下降（27.18±9.34）mmHg与（18.70±11.58）mmHg，与治疗前相比有统计学意义（P<0.05）。④心率结果：治疗4周后观察到诊所和24hABMP平均心率增快分别为（1.55±1.93）次/min与（0.83±1.52）次/min，与治疗前相比有统计学意义（P<0.05），就增幅而言改变不明显。⑤不良反应发生率为5％，程度轻可耐受，无患者退出试验。
结论 左旋氨氯地平作用于轻中度高血压病人可有效降低诊所血压，同时能降低运动中血压，保持24小时血压平稳且不良反应少。提示左旋氨氯地平是一种有效、安全，不良反应少，依从性好的抗高血压药物，适合单独用于轻中度高血压患者的降压治疗。
Objective To evaluate the antihypertensive efficiency and adverse reactions of levamlodipine for patients with mild and moderate essential hypertension (EH).
Methods According to WHO/ISH diagnosis standard to collect pts (patients) with EH. Forty pts with mild or moderate hypertension were given Levamlodipine 2.5mg once daily for 4 weeks. Clinic data of clinic sitting position blood pressure(CBP) and heart rate were measured. If the target diastolic blood pressure of
方法 采用自身用药前后对照方法。根据WHO高血压的诊断标准收集入选患者：选取轻中度高血压患者40例，试验前未服用降压药物或停用其它降压药物1周以上，给予口服左旋氨氯地平2.5mg/d，早餐后服用，连续用药4周，每周复查一次，观察其诊所血压（CBP）、心率、不良反应。如降压疗较差，加量至5mg/d。所有患者于药物治疗前和治疗4周后进行动态血压监测和6分钟步行运动。
结果 40例（男19例）患者均完成试验。①诊所血压结果：治疗4周后平均收缩压（SBP）和舒张压（DBP）分别下降（21.70±9.34）mmHg与（13.50±7.83）mmHg，与治疗前相比有统计学意义（P<0.05）。诊所总有效率为90％。②动态血压监测结果：治疗4周后24h SBP与24h DBP分别下降（16.14±9.94）mmHg与（9.02±8.14）mmHg，与治疗前相比有统计学意义（P<0.05）。治疗4周后白昼夜间SBP、DBP负荷值和夜间血压下降率与治疗前相比明显下降（P<0.05）。24hABMP总有效率为85％。③运动试验结果：治疗4周后运动后即刻SBP和DBP分别下降（27.18±9.34）mmHg与（18.70±11.58）mmHg，与治疗前相比有统计学意义（P<0.05）。④心率结果：治疗4周后观察到诊所和24hABMP平均心率增快分别为（1.55±1.93）次/min与（0.83±1.52）次/min，与治疗前相比有统计学意义（P<0.05），就增幅而言改变不明显。⑤不良反应发生率为5％，程度轻可耐受，无患者退出试验。
结论 左旋氨氯地平作用于轻中度高血压病人可有效降低诊所血压，同时能降低运动中血压，保持24小时血压平稳且不良反应少。提示左旋氨氯地平是一种有效、安全，不良反应少，依从性好的抗高血压药物，适合单独用于轻中度高血压患者的降压治疗。
Objective To evaluate the antihypertensive efficiency and adverse reactions of levamlodipine for patients with mild and moderate essential hypertension (EH).
Methods According to WHO/ISH diagnosis standard to collect pts (patients) with EH. Forty pts with mild or moderate hypertension were given Levamlodipine 2.5mg once daily for 4 weeks. Clinic data of clinic sitting position blood pressure(CBP) and heart rate were measured. If the target diastolic blood pressure of
引文
徐成斌.从ALLHAT研究结果评价长效钙拮抗剂的安全性和有效性[J].中华心血管病杂志,2003,31(6):469～470.
The ALLHAT officers and coordinations for the ALLHAT Collaborative Research Group.Major putcomes in High-Risk Hypertension patients Randomized to ACE inhibitor a calcium channel Blocker vs Diuretic－The Attack Antihypertension and Lipid-lowering Treatment to Prevent Heart Attack Trial (ALLHAT)[J]. JAMA, 2002,288:2981-2997
Arrowsmith JE,Campell SF,Cross PE et al.Long-acting dihydropyridine calcium antagonists.1.2-Alkoxymethyl derivatives incorporating basic substituents[J]. J Med Chem,1986 Sep;29(9):1696-702.
Young JW.Methods and compositions for treating hypertension,angina and other disorders using optically pure(-) Amlodipine. WO 93/10779
张喜田.氨氯地平对映体的拆分.WO 01/60799 A1
中国高血压防治指南起草委员会.中国高血压防治指南[J].高血压杂志，2000,8(1):94～104
孙宁玲，徐成斌.今日高血压[M]. 北京:中国医药科技出版社,2000,501～523
张维忠,施海明,王瑞冬，等.动态血压参数正常参数值协作研究[J].中华心血管病杂志,1995,23(5):325～328
Guyatt GH,Shllivan MJ,Thomps PJ,et al.The six-minute walling ,a new measure of exercise capacity in patients with chronic heart failure[J]. Can Med Assoc J, 1985,132:919~923
陈敏章.，余振球，马长生，等.实用高血压学(第二版)[M].北京:科学出版社，2000，280～302
Omboni S,Parati G,Palatini P,et al.Reproducibility and clinicalvalue of nocturnal hypotension:prospective evidence from the SAMPLE study[J]. Hypertens, 1998,16:733-738
Cusipidi C,Macca G,Sampieri L,et al.Target organ damage and non-dipping patten defined by two sessions of ambulatory blood pressure monitoring in
recently diagonised essential hypertension patients[J]. Hypertens, 2001,19(9):1539-1545
White WB,Morganroth J. Usefulness of ambulatory monitoring of blood pressure in assessing antihypertension therapy[J]. Am J Cardiol, 1989,63: 94～98
孙宁玲,徐成斌.今日高血压[M].北京:中国医药科技出版,2000:610～616
胡大一，赵秀丽，孙宁玲，等.苯磺酸左旋氨氯地平与氨氯地平值治疗原发性轻中度高血压的随机双盲平行研究[J].中国医刊,2002,37(5)
O’Brien E,Atkins N,Staessen J.State of the market.A review of ambulatory blood pressure monitoring devices[J].Hypertens,1995,26:835
O’Brien E,Petrie J,Littler W,et al.The British Hypertension Society protocol for the evaluation of blood pressure measuring devies[J].Hypertens, 1993,11(supple12):S43
Verdechia P. Prognostic value of ambulatory blood pressure:currure evidence and clinical implications[J].Hypertension, 2000,35(3):844-851
黄震华.抗高血压治疗中钙拮抗剂阻滞剂的选用[J].国外医学内科学分册,2000,27(10):423-426
孙宁玲,徐成斌.今日高血压[M]. 北京:中国医药科技出版社,2000:537
Pescatello LS,Dargo AE,Leach CN, et al.Short-term effct of dynamic exercise on arterial blood pressure[J].Circulation, 1991,83:1557-1561
Singh JP,Larson MG,ManolioTA, et al. Blood pressure response during treadmill as a risk factor for new-onset hypertension:the Framingham heart study[J].Circulation,1999,99:1831-1836.
黄海云.运动高血压对高血压的预测价值[J].中国循环杂志,2000,15:230
Chaitman R.运动负荷试验.见：Braunwald E,主编.心脏病学－心血管内科学教科书.第5版.陈灏珠主译.北京:人民卫生出版社,1999,145
The ALLHAT officers and coordinations for the ALLHAT Collaborative Research Group.Major putcomes in High-Risk Hypertension patients Randomized to ACE inhibitor a calcium channel Blocker vs Diuretic－The Attack Antihypertension and Lipid-lowering Treatment to Prevent Heart Attack Trial (ALLHAT)[J]. JAMA, 2002,288:2981-2997
Arrowsmith JE,Campell SF,Cross PE et al.Long-acting dihydropyridine calcium antagonists.1.2-Alkoxymethyl derivatives incorporating basic substituents[J]. J Med Chem,1986 Sep;29(9):1696-702.
Young JW.Methods and compositions for treating hypertension,angina and other disorders using optically pure(-) Amlodipine. WO 93/10779
张喜田.氨氯地平对映体的拆分.WO 01/60799 A1
中国高血压防治指南起草委员会.中国高血压防治指南[J].高血压杂志，2000,8(1):94～104
孙宁玲，徐成斌.今日高血压[M]. 北京:中国医药科技出版社,2000,501～523
张维忠,施海明,王瑞冬，等.动态血压参数正常参数值协作研究[J].中华心血管病杂志,1995,23(5):325～328
Guyatt GH,Shllivan MJ,Thomps PJ,et al.The six-minute walling ,a new measure of exercise capacity in patients with chronic heart failure[J]. Can Med Assoc J, 1985,132:919~923
陈敏章.，余振球，马长生，等.实用高血压学(第二版)[M].北京:科学出版社，2000，280～302
Omboni S,Parati G,Palatini P,et al.Reproducibility and clinicalvalue of nocturnal hypotension:prospective evidence from the SAMPLE study[J]. Hypertens, 1998,16:733-738
Cusipidi C,Macca G,Sampieri L,et al.Target organ damage and non-dipping patten defined by two sessions of ambulatory blood pressure monitoring in
recently diagonised essential hypertension patients[J]. Hypertens, 2001,19(9):1539-1545
White WB,Morganroth J. Usefulness of ambulatory monitoring of blood pressure in assessing antihypertension therapy[J]. Am J Cardiol, 1989,63: 94～98
孙宁玲,徐成斌.今日高血压[M].北京:中国医药科技出版,2000:610～616
胡大一，赵秀丽，孙宁玲，等.苯磺酸左旋氨氯地平与氨氯地平值治疗原发性轻中度高血压的随机双盲平行研究[J].中国医刊,2002,37(5)
O’Brien E,Atkins N,Staessen J.State of the market.A review of ambulatory blood pressure monitoring devices[J].Hypertens,1995,26:835
O’Brien E,Petrie J,Littler W,et al.The British Hypertension Society protocol for the evaluation of blood pressure measuring devies[J].Hypertens, 1993,11(supple12):S43
Verdechia P. Prognostic value of ambulatory blood pressure:currure evidence and clinical implications[J].Hypertension, 2000,35(3):844-851
黄震华.抗高血压治疗中钙拮抗剂阻滞剂的选用[J].国外医学内科学分册,2000,27(10):423-426
孙宁玲,徐成斌.今日高血压[M]. 北京:中国医药科技出版社,2000:537
Pescatello LS,Dargo AE,Leach CN, et al.Short-term effct of dynamic exercise on arterial blood pressure[J].Circulation, 1991,83:1557-1561
Singh JP,Larson MG,ManolioTA, et al. Blood pressure response during treadmill as a risk factor for new-onset hypertension:the Framingham heart study[J].Circulation,1999,99:1831-1836.
黄海云.运动高血压对高血压的预测价值[J].中国循环杂志,2000,15:230
Chaitman R.运动负荷试验.见：Braunwald E,主编.心脏病学－心血管内科学教科书.第5版.陈灏珠主译.北京:人民卫生出版社,1999,145