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目的探讨氨氯地平联合复方阿米洛利或联合替米沙坦对高血压患者中心动脉压(CAP)和脉搏波传导速度(PWV)的影响。方法采用随机抽样方法选取2008-03-2011-02济南4个社区查体人群中高血压患者275例,年龄50～79岁。随机分为氨氯地平联合复方阿米洛利组(A组,134例)或联合替米沙坦组(B组,141例)。排除68例应用调脂药物的患者后,对207例(A组,102例;B组,105例)患者进行分析。在基线、治疗12、24月,分别应用动脉脉搏波分析仪测量CAP和增强指数,应用PWV测定仪测定颈桡动脉PWV(crPWV)。结果两组治疗12月后,中心动脉收缩压、舒张压、脉压,增强指数及crPWV均明显降低。24月时,B组crPWV较12月时进一步降低[(8.9±2.0)比(9.5±2.2)m/s,P<0.05],然而A组患者的crPWV并未随着时间的延长进一步改善(P>0.05)。治疗12和24月后,B组crPWV下降幅度[12月(-3.5±2.1)m/s,24月(-4.1±2.3)m/s]均较A组[12月(-2.3±1.6)m/s,24月(-2.5±1.8)m/s]更明显(均P<0.01)。结论以钙拮抗剂氨氯地平为基础,联合替米沙坦或复方阿米洛利均能够降低CAP、增强指数和改善大动脉顺应性,其中氨氯地平联合替米沙坦改善动脉弹性更明显,并且随着治疗时间的延长,效果更佳。
Objective To investigate the effects of amlodipine combined with amiloride or telmisartan on central arterial pressure (CAP) and pulse wave velocity (PWV) in patients with essential hypertension. Methods A total of 275 hypertensive patients aged 50-79 years were selected from 4 community-based general public in Jinan from 2008-03-2011-02 by random sampling method. Randomly divided into amlodipine combined with amiloride group (A group, 134 cases) or combined telmisartan group (B group, 141 cases). After excluding 68 patients with lipid-lowering drugs, 207 patients (Group A, 102; Group B, 105) were analyzed. At baseline, 12 and 24 months of treatment, the arterial pulse wave analyzer was used to measure the CAP and enhancement index respectively. PWV (crPWV) was measured by PWV detector. Results After 12 months of treatment, systolic blood pressure, diastolic blood pressure, pulse pressure, enhancement index and crPWV of central artery were significantly decreased. At 24 months, crPWV in group B was significantly lower than in December [(8.9 ± 2.0) vs (9.5 ± 2.2) m / s, P <0.05], whereas crPWV did not improve further with time in group A P> 0.05). After 12 and 24 months of treatment, the decrease of crPWV in group B was significantly lower than that in group A [December (-2.3 ± 1.6) months [December (-3.5 ± 2.1) m / s and 24 months (-4.1 ± 2.3) m / m / s in 24 months (-2.5 ± 1.8) m / s] (all P <0.01). CONCLUSION: The combination of amlodipine, a combination of telmisartan and amiloride, can reduce the CAP, enhance the index and improve the compliance of aorta. Amlodipine and telmisartan can improve arterial elasticity more obviously, And with the extension of treatment time, the effect is better.