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目的观察氨氯地平联合缬沙坦治疗社区老年原发性高血压合并糖尿病的临床疗效。方法选择2013年1月—2014年7月广东省东莞市长安社区卫生服务中心沙头第一社区卫生服务站收治的老年原发性高血压合并糖尿病患者100例,随机分成研究组和对照组,各50例。两组患者治疗前两周停止服用其他降压药,对照组患者给予氨氯地平治疗,研究组患者给予氨氯地平联合缬沙坦治疗,均治疗两个月。观察两组患者治疗前后血压〔收缩压(SBP)、舒张压(DBP)〕、血糖〔空腹血糖(FBG)、餐后2 h血糖(2 h PG)〕及胰岛素〔空腹血清胰岛素(FINS)、胰岛素敏感性指数(ISI)〕变化情况。并记录治疗期间两组患者不良反应发生情况。结果研究组患者治疗后SBP下降(27±2)mm Hg、DBP下降(23±4)mm Hg,分别大于对照组的(18±3)mm Hg、(14±3)mm Hg(P<0.05);研究组患者临床疗效优于对照组(u=1.990,P=0.047)。治疗前两组患者FBG、2 h PG、FINS及ISI比较,差异无统计学意义(P>0.05);治疗后研究组患者FBG、2 h PG及FINS低于对照组,ISI高于对照组(P<0.05)。研究组患者不良反应发生率为4.0%,对照组为14.0%,差异无统计学意义(χ2=1.954,P=0.162)。结论缬沙坦联合氨氯地平治疗社区老年原发性高血压合并糖尿病疗效确切,能有效降低患者血压、控制血糖、提高胰岛素敏感性,且安全性较高。
Objective To observe the clinical efficacy of amlodipine combined with valsartan in the treatment of elderly patients with essential hypertension complicated with diabetes mellitus. Methods From January 2013 to July 2014, 100 elderly patients with essential hypertension complicated with diabetes admitted to Chang’an Community Health Service Center, Chang’an Community Health Service Center, Dongguan City, Guangdong Province were randomly divided into study group and control group, 50 cases each. Two groups of patients stopped taking other antihypertensive drugs two weeks before treatment, patients in the control group were treated with amlodipine, and patients in the study group were treated with amlodipine and valsartan for two months. Blood pressure (SBP and DBP), blood glucose (fasting blood glucose, postprandial 2h PG) and insulin (fasting serum insulin (FINS, Insulin sensitivity index (ISI)〕 changes. And recorded during treatment two groups of patients with adverse reactions occurred. Results SBP decreased (27 ± 2) mm Hg and DBP decreased (23 ± 4) mm Hg after treatment in study group compared with that in control group (18 ± 3) mm Hg and (14 ± 3) mm Hg, respectively ). The clinical efficacy of the study group was better than that of the control group (u = 1.990, P = 0.047). There was no significant difference in FBG, PG, FINS and ISI between the two groups before treatment (P> 0.05). After treatment, FBG, PG and FINS in 2 h were lower than those in control group P <0.05). The incidence of adverse reactions was 4.0% in the study group and 14.0% in the control group, with no significant difference (χ2 = 1.954, P = 0.162). Conclusion Valsartan combined with amlodipine is effective in treating elderly patients with essential hypertension complicated with diabetes mellitus, which can effectively reduce blood pressure, control blood sugar, improve insulin sensitivity and have higher safety.