氨氯地平联合复方阿米洛利或替米沙坦对高血压患者降压疗效的相关临床因素分析

中国临床药理学与治疗学 ›› 2010, Vol. 15 ›› Issue (11): 1273-1278.

氨氯地平联合复方阿米洛利或替米沙坦对高血压患者降压疗效的相关临床因素分析

俞蔚¹, 唐新华¹, 王文², 徐小玲¹, 章一丰³, 方顺元⁴, 周爱芬⁵, 王苏英⁶, 傅胜文⁷, 韩丽雅⁸, 金宏义¹

¹浙江医院,浙江省心脑血管病防治研究中心,杭州 310013,浙江;
²阜外心血管病医院,卫生部心血管病防治研究中心,北京 100037;
³绍兴市心脑血管病防治办公室,绍兴 312000,浙江;
⁴杭州市心脑血管病防治办公室,杭州 310000,浙江;
⁵嘉兴市心脑血管病防治办公室,嘉兴 314000,浙江;
⁶丽水市心脑血管病防治办公室,丽水中心医院,丽水 323000,浙江;
⁷金华市中心医院, 金华 321000,浙江;
⁸温州市第二人民医院, 温州 325000,浙江

收稿日期:2010-09-29 修回日期:2010-11-19 出版日期:2010-11-26 发布日期:2020-09-16
通讯作者: 唐新华,女,主任医师,研究方向:高血压人群防治。Tel: 0571-87964761 E-mail: tangxh49@gmail.com
作者简介:俞蔚,女,硕士,副主任医师,研究方向:心血管疾病的内科临床治疗和人群防治。Tel: 0571-87964761 E-mail: yuweipost58@yahoo.com.cn
基金资助:
国家“十一五”科技支撑计划课题(2006BAI01A03)浙江分课题;浙江省科技厅科技计划重大项目(2008C3002-3);浙江省老年医学重点实验室

Effects of amlodipine-based combination amiroride or telmisartan antihypertensive therapy on blood pressure control in hypertensive patients

YU Wei¹, TANG Xin-hua¹, WANG Wen², XU Xiao-ling¹, ZHANG Yi-feng³, FANG Shun-yuan⁴, ZHOU Ai-feng⁵, WANG Shu-ying⁶, FU Sheng-wen⁷, HAN Li-ya⁸, JING Hong-yi¹

¹Zhejiang Hospital, Center of Cardio-Cerebro-Vascular Disease Prevention and Control in Zhejiang Province, Hangzhou 310013, Zhejiang, China;
² Fuwai Cardiology Hospital, National Center for Cardiovascular Diseasse,Beijing 100037, China;
³Department of Cardio-Cerebro-Vascular Disease Prevention and Control in Shaoxing, Shaoxing 312000, Zhejiang, China;
⁴Department of Cardio-Cerebro-Vascular Disease Prevention and Control in Hangzhou, Hangzhou 310000, Zhejiang, China;
⁵Department of Cardio-Cerebro-Vascular Disease Prevention and Control in Jiaxing, Jiaxing 314000, Zhejiang, China;
⁶Department of Cardio-Cerebro-Vascular Disease Prevention and Control in Lishui, Lishui 323000, Zhejiang, China;
⁷Jinghua Municipal Central Hospital,Jinhua 321000,Zhejiang, China;
⁸The Second People's Hospital of Wenzhou, Wenzhou 325000,Zhejiang, China

Received:2010-09-29 Revised:2010-11-19 Online:2010-11-26 Published:2020-09-16

摘要/Abstract

摘要： 目的: 探讨以氨氯地平为基础的联合降压治疗方案不能有效控制高血压患者血压的相关临床影响因素。方法: 2008年3月至10月在浙江省11家医疗机构入选50~79岁伴心血管病危险因素的高血压患者700例,采用多中心、随机、开放、对照的临床试验方法,随机分为氨氯地平加复方阿米洛利组(A组,354例)或氨氯地平加替米沙坦组(B组,346例),进行早期联合药物降压治疗,随访观察8周。根据血压控制情况,A组中分为血压控制亚组(290例)和血压未控制亚组(64例),B组中分为血压控制亚组(272例)和血压未控制亚组(74例)。结果: A、B两组高血压患者的血压控制率分别达81.9％和78.6％。A组中血压未控制亚组的基线收缩压、舒张压和体重指数(BMI)均显著高于血压控制亚组(P<0.01);心率、合并脑血管疾病史较高于血压控制亚组(P<0.05)。B组中血压未控制亚组的血尿酸、蛋白尿均显著高于血压控制亚组(P<0.01);收缩压、舒张压较高于血压控制亚组(P<0.05)。多因素Logistic逐步回归分析显示,BMI、心率和舒张压是氨氯地平加复方阿米洛利联合降压治疗血压未控制的危险因素(OR值分别为1.136、1.047和1.074)。尿酸、尿蛋白是氨氯地平加替米沙坦联合降压治疗血压未控制的危险因素(OR值分别为1.004和1.536)。结论: 舒张压、心率和肥胖是氨氯地平联合复方阿米洛利降压疗效欠佳的主要相关临床因素。尿酸、蛋白尿是氨氯地平联合替米沙坦降压疗效欠佳的主要相关临床因素。

关键词: 高血压, 药物治疗, 联合, 临床因素

Abstract: AIM: To evaluate the effect factors of amlodipine-based combination amiroride or telmisartan antihypertensive therapy on blood pressure uncontrol in hypertensive patients. METHODS: 700 hypertensive patients from 11 centers in Zhejiang province from Mar. to Oct. 2008 were included in this multi-centre randomized controlled clinical trial. Patients were randomly assigned to receive amlodipine plus amiroride (group A, n=354) or amlodipine plus telmisartan (group B, n=346).All patients were followed-up for 8 weeks. RESULTS: Blood press control rates reach 81.9％ and 78.6％ in group A and group B, respectively. In group A, systolic blood pressure(SBP),diastolic blood pressure(DBP) and body mass index(BMI) in blood pressure uncontrol patients were significantly higher than those in blood pressure control (P<0.01). Heart rate(HR) and cerebrovascular disease history in blood pressure uncontrol patients were higher than those in blood pressure control (P<0.05). In group B, urine acid and proteinuria in blood pressure uncontrol patients were significantly higher than those in blood pressure control (P<0.01). The levels of SBP and DBP were higher than those in blood pressure control (P<0.05).Results from multivariate logistic regression model showed that odds ratio of BMI,HR and DBP were 1.136,1.047,1.074, respectively in group A, the odds ratio of UA and proteinuria were 1.004,1.536, respectively in group B. CONCLUSION: DBP, HR and obesity are main clinical factors of blood pressure uncontrol in amlodipine plus amiroride, UA and proteinuria are main clinical factors of blood pressure uncontrol in amlodipine plus telmisartan.

Key words: Hypertension, Drug therapy, Combination, Clinical factor

中图分类号:

R544.1

俞蔚, 唐新华, 王文, 徐小玲, 章一丰, 方顺元, 周爱芬, 王苏英, 傅胜文, 韩丽雅, 金宏义. 氨氯地平联合复方阿米洛利或替米沙坦对高血压患者降压疗效的相关临床因素分析[J]. 中国临床药理学与治疗学, 2010, 15(11): 1273-1278.

YU Wei, TANG Xin-hua, WANG Wen, XU Xiao-ling, ZHANG Yi-feng, FANG Shun-yuan, ZHOU Ai-feng, WANG Shu-ying, FU Sheng-wen, HAN Li-ya, JING Hong-yi. Effects of amlodipine-based combination amiroride or telmisartan antihypertensive therapy on blood pressure control in hypertensive patients[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2010, 15(11): 1273-1278.

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