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目的运用动态血压监测方法观察比较不同时间药物干预对高血压患者血压晨峰的临床效果。方法 2009年1月至2012年4月期间深圳市宝安区人民医院经动态血压检测明确有血压晨峰现象的120例原发性高血压患者作为研究对象,所有患者服用氯沙坦50 mg,按服药时间不同随机分为两组:A组(每日清晨服药1次)和B组(每日睡前服药1次),两组用药2周后再行24 h动态血压监测,记录患者觉醒后2 h的平均收缩压(MSBP)、平均舒张压(MDBP)、最高收缩压(MAXSBP)及最高舒张压(MAXDBP),比较用药前后血压的变化情况。结果两组用药前后MSBP、MDBP、MAXSBP、MAXDBP差异均具有统计学意义(P<0.05);其中A组用药后MSBP平均下降(16.9±8.5)mm Hg,B组MSBP平均下降(20.5±9.3)mm Hg,两者比较差异有统计学意义(P<0.05);A组用药后MDBP平均下降(5.4±5.9)mm Hg,B组MDBP平均下降(6.7±6.3)mm Hg,两者比较差异无统计学意义(P>0.05)。结论晨起或睡前服用氯沙坦均能降低高血压晨峰患者在清晨醒后的血压水平,其中睡前服用氯沙坦能更有效的降低醒后的收缩压水平。
Objective To observe and compare the clinical effect of medication intervention at different times on blood pressure morning peak in patients with hypertension by dynamic blood pressure monitoring. Methods From January 2009 to April 2012, 120 cases of essential hypertension patients with ambulatory blood pressure detected by ambulatory blood pressure test in Bao’an District People’s Hospital of Shenzhen City from January 2009 to April 2012 were enrolled. All patients were given losartan 50 mg The patients were randomly divided into two groups: group A (once daily in the morning) and group B (once daily at bedtime). Two weeks after the two groups were administered, ambulatory blood pressure monitoring was performed 24 hours later. The mean systolic blood pressure (MSBP), mean diastolic pressure (MDBP), maximum systolic blood pressure (MAXSBP) and maximum diastolic blood pressure (MAXDBP) of 2 h were compared to compare the changes of blood pressure before and after treatment. Results The differences of MSBP, MDBP, MAXSBP and MAXDBP before and after treatment in both groups were statistically significant (P <0.05). MSBP in group A was decreased by (16.9 ± 8.5) mm Hg on average after treatment, and mean MSBP in group B was decreased by 20.5 ± 9.3 mm Hg, the difference was statistically significant (P <0.05). The average MDBP level in group A was (5.4 ± 5.9) mm Hg, while that in group B was 6.7 ± 6.3 mm Hg Statistical significance (P> 0.05). Conclusion Losartan before and after bedtime can reduce the blood pressure of patients with morning sickness in early morning after waking up, and taking Losartan before bedtime can reduce the level of systolic pressure more effectively.