标题：阿罗洛尔联合缬沙坦氢氯噻嗪治疗老年顽固性高血压临床疗效及安全性分析

      作者：陈跃武，刘先霞，陈磊，陈家显，张远生，赵勇，吴学正，吴小燕，陈卫卫    (海南医学院第二附属医院心血管内科 海南 海口 570000)

      卷次： 2017年28卷24期

      【摘要】 目的 探讨并分析阿罗洛尔与缬沙坦氢氯噻嗪联合应用治疗老年顽固性高血压的临床疗效与安全性。方法 入选海南医学院第二附属医院心内科2013年1月至2015年12月收治的老年顽固性高血压患者90例，依据入院顺序采用随机队列分配法分为A组(缬沙坦氢氯噻嗪组)、B组(阿罗洛尔组)、C组(阿罗洛尔+缬沙坦氢氯噻嗪组)，每组30例。A组口服缬沙坦氢氯噻嗪片，B组口服盐酸阿罗洛尔，C组口服盐酸阿罗洛尔联合缬沙坦氢氯噻嗪片治疗；连续用药4周后，分别于治疗前及治疗第二周末、第4周末，检测收缩压(SBP)及舒张压(DBP)、心率，记录不良反应发生例数并评估疗效；同时在治疗前、治疗4周末各测定1次血生化指标：包括谷丙转氨酶、谷草转氨酶、肌酐、血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、尿酸、血钾(K+)、钠(Na+)、氯(Cl-)及心电图。结果 三组患者年龄、性别、病程、心率、体重指数等基线指标比较差异均无统计学意义(P>0.05)。在整个研究中有5例失访，2例退出试验，共有83例完成试验。在给药降压第四周末时，A组、B组、C组血压(SBP/DBP)分别降至(142.7±8.1) mmHg/(96.3±4.2) mmHg、(140.8±9.7) mmHg/(93.5±9.3) mmHg、(138.7±6.6) mmHg/(82.7±5.4) mmHg，其中C组(92.1%)降压总有效率明显高于A组(73.7%)和B组(78.9%)，差异均有统计学意义(P<0.05)，B组及C组心率较治疗前基线血压水平均有下降，差异有统计学意义(P<0.05)；三组患者治疗后血糖、血脂、尿酸、血钾及肝肾功能等生化指标均无明显变化，差异均无统计学意义(P>0.05)；各组均无严重不良反应发生。结论 阿罗洛尔联合缬沙坦氢氯噻嗪治疗老年顽固性高血压降压疗效显著，是一种临床安全可靠的联合用药方案。
      【关键词】 高血压；老年性；顽固性；盐酸阿罗洛尔；缬沙坦氢氯噻嗪
      【中图分类号】 R544.1 【文献标识码】 A 【文章编号】 1003—6350（2017）24—3969—04

Curative effect and safety of Arotinolol Hydrochlorid combining Valsartan Hydrochlorothiazide Tablets on senileresistant hypertension.
CHEN Yue-wu, LIU Xian-xia, CHEN Lei, CHEN Jia-xian, ZHANG Yuan-sheng, ZHAO Yong,WU Xue-zheng, WU Xiao-yan, CHEN Wei-wei. Department of Cardiology, the Second Affiliated Hospital of HainanMedical College, Haikou 570000, Hainan, CHINA
【Abstract】 Objective To explore and analyze the clinical curative effect and safety of Arotinolol Hydrochloridcombined with Valsartan Hydrochlorothiazide Tablets in the treatment of senile resistant hypertension. Methods FromJanuary 2013 to December 2015, 90 elderly patients with resistant hypertension treated in Department of Cardiology inour hospital were selected, which were randomly divided into group A (given orally Valsartan Hydrochlorothiazide Tab-lets, n=30), group B (given orally Arotinolol Hydrochlorid Tablets, n=30) and group C (given orally Valsartan Hydrochlo-rothiazide Tablets and Arotinolol Hydrochlorid Tablets, n=30). After continuous treatment for 4 weeks, systolic bloodpressure (SBP), diastolic blood pressure (DBP), heart rate were detected respectively before treatment at the end of thesecond week and forth week after treatment. Reverse reactions were recorded and curative effect was reviewed. At thesame time, blood biochemical indexes were detected, including alanine transaminase (Alt), aspertate aminotransferase(AST), creatinine, blood glucose, total cholesterol, three acylglycerin, high-density lipoprotein cholesterol, uric acid, potas-sium (K+), sodium (Na+), chloride (Cl-). Electrocardiogram (ECG) was also observed. Results There was no statisticallysignificant difference in patients' age, gender, duration, heart rate and body indexes among the three groups (all P>0.05).Among the 90 patients, 83 completed the whole study, with 5 patients missed in the follow-up and 2 patients dropping out.At the end of the second week and forth week after treatment, the SBP/DBP was (142.7±8.1) mmHg/(96.3±4.2) mmHg ingroup A, (140.8±9.7) mmHg/(93.5±9.3) mmHg in group B, (138.7±6.6) mmHg/(82.7±5.4) mmHg in group C. The totaleffective rate was higher in group C (92.1%) than that in group A (73.7%) or group B (78.9%), all P<0.05. Heart rate ingroup B and group C were significantly decreased compared with baseline level before treatment (P<0.05). Three groupsshowed no statistically significant difference after treatment in blood sugar, blood lipid, uric acid, potassium, liver andkidney function (P>0.05). No serious adverse reactions were found in the three groups. Conclusion The therapy ofArotinolol Hydrochlorid combining Valsartan Hydrochlorothiazide Tablets has significant curative effect and is safe andreliable in treatment of senile resistant hypertension.
      【Key words】 Hypertension; Senile; Resistant; Arotinolol Hydrochlorid; Valsartan Hydrochlorothiazide·论 著·doi:10.3969/j.issn.1003-6350.2017.24.004基金项目：海南省2014年社会发展科技专项基金(编号：SQ2014SHFZ0138)