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目的比较硝苯地平控释片和非洛地平缓释片对冬夏两季清晨血压和动态血压达标率的影响。方法入选轻中度原发性高血压患者158例随机分为两组:硝苯地平组(30mg/d,n=79)和非洛地平组(5mg/d,n=79)。所有患者均于2012年秋季纳入试验,治疗至少8周后分别于冬季和夏季均行24h动态血压监测,研究周期为12个月。结果与夏季比较,两组患者冬季24h、日间、夜间平均血压显著增高,清晨血压达标率和动态血压达标率明显降低(均P<0.05);尽管夏季两组血压差异无统计学意义,但硝苯地平组24h平均收缩压、24h平均舒张压、日间平均收缩压以及夜间平均收缩压的冬夏血压差值[(5.5±1.2)、(3.5±1.0)、(4.2±2.2)、(5.6±1.2)mm Hg]明显低于非洛地平组[(9.9±1.3)、(4.7±1.4)、(8.5±1.5)、(7.1±1.2)mm Hg](均P<0.05)。硝苯地平组冬季清晨血压和日间收缩压的变异性[(10.3±4.2)、(8.5±3.2)mm Hg]明显低于非洛地平组[(13.3±4.4)、(10.7±3.9)mm Hg](均P<0.05)。与非洛地平组相比,硝苯地平组能明显提高冬季清晨血压达标率(58.2%比41.8%,P=0.039)和冬季日间血压达标率(60.8%比43.0%,P=0.026)。另外,经多元回归分析发现,降血压药物类别、年龄、体质量指数、季节和吸烟史是影响清晨血压的主要因素。结论与非洛地平缓释片比较,硝苯地平控释片明显降低冬夏血压差值,减少血压波动,提高冬季清晨血压和日间血压达标率。
Objective To compare the effects of nifedipine and felodipine sustained release tablets on blood pressure and ambulatory blood pressure compliance in early winter and summer. Methods 158 patients with mild to moderate essential hypertension were randomly divided into two groups: nifedipine group (30mg / d, n = 79) and felodipine group (n = 79). All patients were enrolled in the fall of 2012. At least 8 weeks after treatment, ambulatory blood pressure monitoring was performed 24h in winter and summer, respectively, and the study period was 12 months. Results Compared with summer, the average blood pressure in winter, daytime and night in winter increased significantly in both groups, and the rate of blood pressure compliance and ambulatory blood pressure compliance in early morning were significantly decreased (both P <0.05). Although there was no significant difference in blood pressure between the two groups in summer, The mean systolic blood pressure at 24h, mean systolic blood pressure at 24h, mean systolic blood pressure during daytime and nighttime systolic blood pressure were significantly lower in nifedipine group than those in nifedipine group [(5.5 ± 1.2), (3.5 ± 1.0), (4.2 ± 2.2), ± 1.2 mm Hg] were significantly lower than those in the felodipine group ([(9.9 ± 1.3), (4.7 ± 1.4), (8.5 ± 1.5), (7.1 ± 1.2) mm Hg] (all P <0.05). The variability of blood pressure and daytime systolic blood pressure in the nifedipine group [(10.3 ± 4.2), (8.5 ± 3.2) mm Hg] was significantly lower than that in the felodipine group [(13.3 ± 4.4), (10.7 ± 3.9) mm Hg] (all P <0.05). Compared with the felodipine group, the nifedipine group significantly improved blood pressure compliance (58.2% vs. 41.8%, P = 0.039) and winter day blood pressure compliance (60.8% vs. 43.0%, P = 0.026) in winter. In addition, multivariate regression analysis found that antihypertensive drugs, age, body mass index, season and smoking history are the main factors affecting early morning blood pressure. Conclusion Compared with felodipine extended release tablets, nifedipine controlled release tablet significantly decreased the difference of winter and summer blood pressure, decreased the fluctuation of blood pressure, and improved the blood pressure and daytime blood pressure compliance rate in winter.