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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:

35

期数:

2018年8

页码:

701-704

栏目:

临床研究

出版日期:

2018-08-05

文章信息/Info

Title:

Effect of olmesartan combined with amlodipine on vascular endothelial function and blood pressure variability in hypertensive patients with diabetes

作者:

郭山岭

（濮阳市安阳地区医院心内一科，河南　安阳　455000）

Author(s):

GUO Shan-ling

（The First Department of Cardiology，Anyang District Hospital of Puyang，Anyang 455000，Henan Province，China）

关键词:

奥美沙坦; 氨氯地平; 高血压合并糖尿病; 血管内皮功能; 血压变异性

Keywords:

olmesartan; amlodipine; hypertension associated with diabetes mellitus; vascular endothelial function; blood pressure variability

分类号:

R544.1；R587.1

DOI:

10.7683/xxyxyxb.2018.08.013

文献标志码:

A

摘要:

目的　观察奥美沙坦联合氨氯地平治疗高血压并发糖尿病患者的临床疗效及其对血管内皮功能、血压变异性的影响。方法　选择2016年1月至2017年1月安阳地区医院收治的高血压并发2型糖尿病患者 214例为研究对象，根据治疗方法将患者分为氨氯地平组（n=71）、奥美沙坦组（n=71）和联合组（n=72）。3组患者均给予常规治疗，在常规治疗基础上，氨氯地平组患者口服苯磺酸氨氯地平片5 mg，奥美沙坦组患者口服奥美沙坦酯20 mg，联合组患者口服苯磺酸氨氯地平片5 mg和奥美沙坦酯20 mg，均为每日1次，治疗3个月。分别于治疗前及治疗后采用放射免疫法检测各组患者血清内皮素-1（ET-1）水平，硝酸还原酶法测定血清一氧化氮（NO）水平，酶联免疫吸附试验检测血清血管性血友病因子（vWF）水平；记录各组患者治疗前及治疗后血压变异性指标；观察各组患者的治疗效果及不良反应。结果　氨氯地平组、奥美沙坦组和联合组患者的治疗总有效率分别85.9%、87.3%和94.4%，联合组患者治疗总有效率显著高于氨氯地平组和奥美沙坦组（χ²=0.973、0.831，P<0.05），氨氯地平组和奥美沙坦组总有效率比较差异无统计学意义（χ²=0.805，P>0.05）。治疗前3组患者血清EF-1、NO和vWF水平比较差异均无统计学意义（P>0.05）；3组患者治疗后血清EF-1、vWF水平低于治疗前，NO水平高于治疗前（P<0.05）；治疗后，联合组患者血清EF-1、vWF水平低于氨氯地平组和奥美沙坦组，NO水平高于氨氯地平组和奥美沙坦组（P<0.05）；氨氯地平组和奥美沙坦组患者血清EF-1、vWF和NO水平比较差异无统计学意义（P>0.05）。治疗前3组患者24 h平均舒张压（24 h DBP）、24 h平均收缩压（24 h SBP）、24 h收缩压标准差（24 h SSD）和24 h舒张压标准差（24 h DSD）比较差异均无统计学意义（P>0.05）；3组患者治疗后24 h DBP、24 h SBP、24 h SSD和24 h DSD均低于治疗前（P<0.05，P<0.01）；治疗后，联合组患者24 h DBP、24 h SBP、24 h SSD和24 h DSD均低于氨氯地平组和奥美沙坦组（P<0.05）;氨氯地平组与奥美沙坦组上述各指标比较差异无统计学意义（P>0.05）。氨氯地平组、奥美沙坦组和联合组患者不良反应发生率分别为2.82%（2/71）、4.23%（3/71）和4.17%（3/72），3组患者不良反应发生率比较差异无统计学意义（χ²=0.415，P>0.05）。结论　奥美沙坦联合氨氯地平治疗高血压并发糖尿病患者的临床效果优于单一用药，其机制可能与降低血压变异性、改善血管内皮功能有关。

Abstract:

Objective　To observe the clinical efficacy of olmesartan combined with amlodipine in the treatment of hypertensive patients with diabetes and its effect on vascular endothelial function and blood pressure variability.Methods　Two hundred and fourteen patients with hypertension and type 2 diabetes in Anyang District Hospital from January 2016 to January 2017 were selected and divided into amlodipine group（n=71），olmesartan group（n=71） and combination group（n=72） according to the treatment method.All patients were given conventional treatment，based on this，the patients in the amlodipine group received oral amlodipine besylate tablets 5 mg，one time per day；the patients in the olmesartan group received oral olmesartan 20 mg，one time per day；the patients in the combination group received oral amlodipine besylate tablets 5 mg and olmesartan ester 20 mg，one time per day；all patients were treated for 3 months.The level of endothelin-1（EF-1） in serum was measured by radioimmunoassay，the nitric oxide （NO） level was measured by nitrate reductase method and the level of von Willebrand factor（vWF） in serum was detected by enzyme-linked immunosorbent assay before and after treatment in each group.The blood pressure variability indicators were recorded before and after treatment in the three groups.The patient′s treatment effect and the occurrence of adverse reactions were recorded in the three groups.Results　The total effective rate of patients in amlodipine group，olmesartan group and combination group was 85.9%，87.3% and 94.4%；the total effective rate of patients in the combination group was significantly higher than that in the amlodipine group and olmesartan group（χ²=0.973，0.831；P<0.05）；there was no significant difference in the total effective rate between the amlodipine group and olmesartan group （χ²=0.805，P>0.05）.There was no significant difference in the serum EF-1，NO，and vWF levels among the three groups before treatment （P>0.05）.After treatment，the serum levels of EF-1 and vWF in the three groups were lower than before treatment，and the NO levels was higher than before treatment （P<0.05）.After treatment，the serum levels of EF-1 and vWF in the combination group were significantly lower than those in the amlodipine group and olmesartan group，and the NO level was significantly higher than that in the amlodipine group and olmesartan group （P<0.05）；there was no statistic difference in the levels of EF-1,vWF and NO btween the amlodipine group and olmesartan group(P>0.05).There was no significant difference in the 24 h mean diastolic blood pressure（24 h DBP），24 h mean systolic blood pressure（24 h SBP），24 h systolic pressure standard deviation（24 h SSD），and 24 h standard deviation of diastolic pressure（24 h DSD） among the three groups before treatment （P>0.05）.The levels of 24 h DBP，24hSBP，24hSSD，and 24hDSD after treatment were significantly lower than those before treatment in the three groups （P<0.05，P<0.01）.After treatment，the 24 h DBP，24 h SBP，24 h SSD，and 24 h DSD in combination group were significantly lower than those in the amlodipine group and olmesartan group （P<0.05）;there was no statistic difference in above indexes between the amlodipine group and almesartan group(P>0.05).The incidence of adverse reactions of patients in the amlodipine group，olmesartan group and combination group was 2.82% （2/71），4.23% （3/71），and 4.17% （3/72），respectively；there was no significant difference in the incidence of adverse reactions among the three groups（χ²=0.415，P>0.05）.Conclusion　The clinical effect of olmesartan combined with amlodipine in treatment of hypertensive patients with diabetes are is superior to that of olmesartan or amlodipine alone olmesartan.The mechanism may be related to reducing blood pressure variability and improving vascular endothelial function.

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更新日期/Last Update: 2018-08-05