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目的探讨在降压药物种类和数量相同的情况下,通过改变坎地沙坦的服药时间对老年高血压患者血压节律的影响。方法将157例经非洛地平和氢氯噻嗪治疗4周后复查24h动态血压监测(ABPM)证实血压仍控制不理想的老年高血压患者随机分为2组:A组于早晨加用坎地沙坦,B组于夜间睡前加用坎地沙坦;治疗随访8周后复查ABPM。结果两组治疗后,24h平均收缩压和舒张压降低。B组患者夜间平均收缩压和舒张压以及24h平均收缩压和舒张压的降低幅度显著高于A组(均P<0.01);夜间收缩压下降率的变化幅度[(3.2±7.1)%比(-2.5±6.4)%]、夜间舒张压下降率的变化幅度[(5.9±7.2)%比(-0.5±6.8)%]高于A组(均P<0.05)。B组非杓型血压比例下降38.8%,而A组增加7.2%(P<0.01)。结论夜间服用坎地沙坦可更有效地降低老年高血压患者的夜间及24h血压。
Objective To investigate the effect of candesartan on the blood pressure rhythm in elderly patients with hypertension under the same type and amount of antihypertensive drugs. Methods A total of 157 elderly hypertensive patients with unsatisfactory blood pressure control were enrolled in this study. 157 patients were treated with candesartan, Group B was given candesartan at bedtime before going to bed at night; ABPM was reviewed after 8 weeks of treatment. Results After treatment, average systolic and diastolic blood pressure decreased 24h. The average nighttime systolic and diastolic blood pressure and the mean systolic and diastolic blood pressure were significantly lower in group B than those in group A (all P <0.01). The rate of decrease in nocturnal systolic pressure was significantly lower than that in group B [(3.2 ± 7.1)% vs -2.5 ± 6.4)%]. The rate of change of nocturnal diastolic blood pressure was higher than that of group A (5.9 ± 7.2% vs (± 0.5 ± 6.8%), P <0.05). The proportion of non-dipper blood pressure in group B decreased by 38.8%, while that in group A increased by 7.2% (P <0.01). Conclusions Candesartan at night is more effective in lowering nocturnal and 24 h BP in elderly hypertensive patients.