心理因素及护理干预措施对高血压老年患者治疗依从性的影响

目的探讨心理因素对高血压老年患者依从性的影响,通过护理干预,提高患者的依从性,从而提高治疗效果。方法选择本院收治的76例未坚持系统治疗,已停用或擅自更改原有降压药物2周以上,血压波动在收缩压140~170 mm Hg,舒张压85~110 mm Hg老年高血压复诊患者。结果 76例患者严格按医嘱服药2周后连续检测血压,76例患者收缩压为(133.36±8.44)mm Hg,最高值150 mm Hg,舒张压稳定在(75.84±6.14)mm Hg,最高值94 mm Hg。治疗有效率75.83%。半年后检测血压,76例患者收缩压为(127.53±4.58)mm Hg,最高值138 mm Hg,舒张压稳定在(73.16±2.83)mm Hg,最高值80 mm Hg。治疗有效率100%。结论心理因素是临床上影响患者依从性的主要原因之一,通过护理干预能有效提高患者治疗的依从性。     

硝苯地平控释片与非洛地平缓释片在难治性高血压患者中的应用效果对比

目的对比硝苯地平控释片与非洛地平缓释片治疗难治性高血压患者的临床效果。方法101例难治性高血压患者作为研究对象,通过随机综合平衡法分为A组(50例)和B组(51例)。A组采用硝苯地平控释片进行治疗,B组采用非洛地平缓释片进行治疗。比较两组患者治疗前后舒张压、收缩压、心率及不良反应发生情况、用药依从率。结果治疗后,B组收缩压(124.65±5.17)mm Hg(1 mm Hg=0.133 kPa)、舒张压(77.38±4.89)mm Hg、心率(53.44±6.85)次/min均低于A组的(135.53±5.18)mm Hg、(86.52±4.77)mm Hg、(61.32±6.83)次/min,差异有统计学意义(P<0.05)。两组不良反应发生率及用药依从率比较差异均无统计学意义(P>0.05)。结论应用非洛地平缓释片治疗难治性高血压能够达到良好的降压效果,安全性强,患者的用药依从性高,说明该治疗方式值得临床推广应用。     

时间治疗学对非勺型难治性高血压的影响

目的 探讨夜间睡前给药对非勺型难治性高血压患者的血压控制效果.方法 按随机数字表法分组,观察组为30例难治性高血压患者且经过动态血压监测证实有非勺型血压,将非利尿剂减压药从晨服改为睡前服,22例非勺型难治性高血压采取晨服相同降压药作为对照组,用药12周后比较两组的患者的血压降低情况和血压昼夜节律的变化.结果 服药12周后,观察组患者的24 h平均收缩压/舒张压、白天平均舒张压、夜间平均收缩压/舒张压比治疗前变化值分别为(-2.8±4.2)/(-2.1±3.4)mm Hg、(-1.1±3.1) mm Hg和(-6.3±5.9)/(-4.3±5.7)mm Hg,与对照组比较,观察组降压效果更好(均P＜0.05);观察组血压的昼夜节律6例变为勺型血压,对照组昼夜节律没有变化,差异有统计学意义(x2=4.974,P=0.0263).两组不良反应无明显差异.结论 夜间服药更有利于非勺型难治性高血压患者的血压降低和恢复血压正常昼夜节律.     

社区护理干预对高血压患者血压水平的影响分析

目的探究社区护理干预对高血压患者血压水平的影响。方法选取本辖区100例高血压患者,随机分为实验组和对照组,对照组患者使用常规的降压药物治疗,实验组患者在降压药物治疗同时给予针对性护理干预,比较两组患者血压控制情况。结果干预后,两组患者的收缩压、舒张压:实验组(128±12)mm Hg、(82±6)mm Hg;对照组(162±10)mm Hg、舒张压(98±14)mm Hg,实验组的控制水平明显好于对照组(P<0.05);实验组饮食、运动、认知的改善程度明显好于对照组(P<0.05)。结论为高血压患者实施社区护理干预可以有效的降低血压,维持血压在一定的水平。     

个体化护理对老年高血压患者血压及并发症的影响

目的分析老年高血压患者利用个体化护理对患者血压及并发症的影响。方法随机选择2013年8月至2015年8月在本院接受治疗的高血压患者80例参与研究,随机平均分成2组,对照组对患者进行常规护理,观察组对患者实施个体化护理,比较两组血压情况以及并发症发生情况。结果观察组护理后舒张压和收缩压分别为(78.0±4.5)mm Hg、(125.2±10.3)mm Hg,对照组(89.7±4.4)mm Hg、(138.5±11.4)mm Hg;观察组并发症发生率10%,对照组22.5%。结论个体化护理用于老年高血压患者护理中,能够稳定患者血压,降低并发症的发生率,值得推广。     

家庭医生式服务对社区原发性高血压患者治疗依从性及控制率的影响

目的探讨家庭医生式服务对社区原发性高血压患者治疗依从性及控制率的影响。方法选取2011年8月~2016年11月我社区卫生服务中心收治的原发性高血压患者200例作为研究对象,随机分为两组,对照组采用常规对症治疗,观察组在常规对症治疗基础上给予家庭医生式服务干预,对两组患者的病情进行了为期6个月的追踪调查,分析两组患者治疗依从性及控制率。结果观察组患者干预6个月后收缩压(129.6±7.3)mm Hg,舒张压(80.2±5.8)mm Hg;对照组收缩压(143.2±6.7)mm Hg,舒张压(90.5±8.4)mm Hg,观察组血压控制情况低于对照组(P<0.05);干预后,两组患者高血压控制率以及配合治疗的依从性,均有所提高,其中观察组高血压控制率为90.0%,对照组为57.0%;观察组配合治疗的是93.0%,对照组63.0%,观察组明显高于对照组(P<0.05)。结论实施家庭医生服务,能够明显提高患者血压控制率和治疗依从性,对治疗高血压疾病有着较大帮助,是一项值得大力推广的、降低老年高血压患者发病率的有效措施。     

临床药学服务对高血压患者用药合理性及依从性的影响

目的探讨高血压患者实施临床药学服务对其用药合理性及依从性的影响。方法选取2016年3月~2017年3月本院收治的实行常规用药干预的57例高血压患者作为对照组,另选2017年4月~2018年4月本院收治的实行临床药学服务的57例高血压患者作为观察组。对比两组患者的药物使用不合理率、用药依从率以及干预前后血压指标。结果观察组干预后药物使用不合理率3.51%明显低于对照组的19.30%,差异具有统计学意义(P<0.05)。观察组干预后用药依从率94.74%和对照组的75.44%比较显著更高,差异具有统计学意义(P<0.05)。干预前,两组舒张压、收缩压水平比较,差异均无统计学意义(P>0.05);干预3个月后,观察组舒张压、收缩压水平分别为(82.48±2.28)、(121.45±4.23)mm Hg(1 mm Hg=0.133 kPa),均显著低于对照组的(93.42±3.65)、(136.06±6.32)mm Hg,差异均具有统计学意义(P<0.05)。结论高血压患者实行临床药学服务的效果显著,能控制血压指标始终处于正常范围,明显提高治疗依从性,并使药物使用不合理率降低。因此,其具备临床推广及应用的价值。     

老年与青年高血压病患者脉压和血压变异性比较

目的 比较老年和青年高血压病患者动态血压的差异,为老年高血压病患者的治疗提供依据.方法 我院高血压科就诊的83例2周内未服药的高血压病患者,60岁≤年龄＜80岁患者40例作为老年组,18岁≤年龄≤30岁患者43例作为青年组.2组患者均进行24 h动态血压监测,并比较结果.结果 老年高血压组的动态脉压、动态脉压指数和24h收缩压变异系数明显高于青年高血压组[(61±12) mm Hg(1 mm Hg=0.133 kPa)比(52 ±9)mm Hg,(0.44±0.07)比(0.37±0.06),(11±2)％比(8±2)％,均P＜0.01];24 h平均舒张压和24h平均心率明显低于青年高血压组[(79±10) mm Hg比(88±12)mm Hg,(69±8)次/mint比(74±9)次/min,均P＜0.01].结论 老年高血压病患者主要以动态脉压增大和24h收缩压变异性升高为特点;而青年患者以24h平均舒张压升高为主.因此,临床对老年高血压病患者进行降压治疗时,选择的药物不仅要有效降低平均收缩压水平,还要改善脉压和血压变异性.     

血管紧张素转化酶抑制剂加钙离子拮抗剂联合用药治疗模式对于轻、中度原发性高血压的临床疗效观察及其对血尿酸水平的影响

目的:比较卡托普利与氨氯地平联合用药与氨氯地平单独使用对于轻、中度原发性高血压患者的血压的调控及其血尿酸水平的影响。方法:选取本院门诊轻、中度原发性高血压患者80例进行随机、双盲的临床研究,所有患者经过2周清洗期后随机分为两组,其中联合用药组40例,采用卡托普利25 mg/次,每天2次,加氨氯地平5 mg/d处理;钙拮抗剂组40例,采用氨氯地平5 mg/d处理,为期8周。对比观察治疗前后血压变化情况。采用全自动生化分析仪检测治疗前后患者空腹血尿酸的变化情况。结果:联合用药组治疗4周后,平均坐位舒张压由治疗前的(98±7)mm Hg(1 mm Hg=0.133 kPa)下降至(92±8)mm Hg;治疗8周后,平均坐位舒张压为(86±11)mm Hg,治疗后较治疗前显著降低(P<0.05)。钙拮抗剂组,治疗前平均坐位舒张压为(96±8)mm Hg,治疗4周后,平均坐位舒张压为(95±7)mm Hg,与治疗前比较无统计学差异(P>0.05);治疗8周后,平均坐位舒张压为(90±8)mm Hg,较治疗前显著降低(P<0.05)。治疗8周后,两组间平均坐位舒张压下降幅度比较,联合用药组降低更为显著(P<0.05)。联合治疗与钙拮抗剂都能降低患者的血尿酸水平,联合用药组降低程度明显高于钙拮抗剂组(P<0.05)。结论:早期联合用药治疗轻、中度高血压患者,能够很好地控制轻、中度高血压,同时能够更好地发挥对重要脏器的保护作用。     

动态血压监测血压变化与高血压脑血管突发事件相关性分析

目的 探讨动态血压监测研究高血压患者血压变化与脑血管突发事件相关性的应用价值.方法 选择135例高血压患者,其中32例发生脑血管突发事件设为观察组,103例未发生脑血管突发事件设为对照组,分析两组动态血压监测结果.结果 观察组24h平均收缩压为(152±10)mm Hg、舒张压为(93±11)mm Hg,显著高于对照组的(133±11)mm Hg、(80±9)mm Hg(t=-0.256、-0.198,均P＜0.05);观察组白昼平均收缩压为(158±15)mm Hg、舒张压为(96±7)mm Hg,显著高于对照组的(137±13)mm Hg、(83±8)mm Hg(t=-0.325、-0.223,均P＜0.05);观察组夜间平均收缩压为(151±12)mm Hg、舒张压为(90±7)mm Hg,显著高于对照组的(132±14)mm Hg、(79±9)mm Hg(t =0.268、-0.166,均P＜0.05).结论 高血压患者血压动态变化与脑血管突发事件紧密相关,对脑血管突发事件的预防有指导意义.     

Trough-to-peak ratio,smoothness index,and circadian blood pressure profile after treatment with once-daily fixed combination of losartan 100 and hydrochlorothiazide 25 in essential hypertension

The once-daily fixed combination of losartan 100 mg/hydrochlorothiazide 25 mg was evaluated for safety and efficacy in a multicenter open study by using 24-h ambulatory blood pressure monitoring in untreated patients with moderate-to-severe essential hypertension or patients with uncontrolled hypertension despite treatment with monotherapy or low-dose combination. After a 2-week washout period, 41 patients (22 men, 19 women) aged 34-74 years, showing a mean daytime blood pressure > 135/85 mm Hg, were treated with losartan 100 mg/hydrochlorothiazide 25 for 8 weeks. Ambulatory blood pressure was monitored at the end of the washout period and during the last week of treatment. A significant reduction in the average values of clinic blood pressure (from 169.9 +/- 13.5 mm Hg to 139.5 +/- 15.6 mm Hg, p < 0.001 for systolic blood pressure [SBP]; and from 102.2 +/- 7.1 mm Hg to 85.1 +/- 9.5 mm Hg, p < 0.001 for diastolic blood pressure [DBP]) was observed after treatment in the whole group of 41 patients. Likewise, average values of both 24-h SBP and 24-h DBP were significantly reduced (from 145.7 +/- 13.1 mm Hg to 128.3 +/- 14.6 mm Hg, p < 0.001 for 24-h SBP; and from 90.3 +/- 7.3 mm Hg to 79.2 +/- 8.6 mm Hg, p < 0.001 for 24-h DBP). The average lowering at peak was 20.2 +/- 11.8 mm Hg for 24-h SBP and 12.1 +/- 7.4 mm Hg for 24-h DBP, whereas the lowering at trough was 17.8 +/- 12.0 mm Hg and 10.4 +/- 8.1 mm Hg, respectively. The trough-to-peak ratio (T/P) was 0.88 for SBP and 0.86 for DBP, and the smoothness index was 7.36 for SBP and 6.37 for DBP. The response rate was 87.8% (blood pressure lowering > 5 mm Hg of either 24-h SBP or 24-h DBP average values). Among responders, T/P ratio was 0.89 for SBP and 0.87 for DBP, and the smoothness index was 8.09 for SBP and 7.15 for DBP. No side effects or changes in metabolic parameters were observed. The fixed combination of losartan 100 mg/hydrochlorothiazide 25 was very effective and well tolerated.     

Effects of amlodipine-atorvastatin combination on inflammation markers and insulin sensitivity in normocholesterolemic obese hypertensive patients

Objective The objective of this study was to assess the effect of amlodipine-atorvastatin combination on plasma interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and insulin sensitivity in normocholesterolemic obese hypertensive patients.Materials and methods After a 4-week placebo wash-out period, 50 normocholesterolemic [total cholesterol (TC) <5.2 mmol/L], obese (BMI ≥30 kg/m²) hypertensive patients (DBP >90 and <105 mm Hg and SBP >140 and <180 mm Hg) were randomly treated with amlodipine (10 mg) or with amlodipine (10 mg) plus atorvastatin (20 mg) according to a cross-over design; each treatment had a 12-week duration. At the end of the placebo and of each treatment period, blood pressure (BP), TNF-α, IL-6, insulin resistance (IR) by homeostasis model assessment of IR index (HOMA-IR) and TC were evaluated.Results Amlodipine monotherapy decreased both SBP (−17.1 mm Hg, p=0.008 vs. placebo) and DBP (−14.3 mm Hg, p=0.008) as well as TNF-α (from 3.66±1.6 to 3.09±1.1 pg/ml, p=0.045) and HOMA-IR (from 4.58±0.7 to 3.88±0.6, p=0.007). The amlodipine-atorvastatin combination produced a decrease in SBP (−22.5 mm Hg, p=0.0007 vs. placebo, p=0.039 vs. amlodipine), DBP (−17.7 mm Hg, p=0.0007 vs. placebo; p=0.04 vs. amlodipine), TNF-α (2.59±0.9 pg/mL, p=0.007 vs. placebo and p=0.038 vs. amlodipine) and HOMA-IR (2.86±0.4, p=0.0008 vs. placebo and p=0.007 vs. amlodipine). The combination reduced IL-6 (from 7.93±1.9 to 5.59±1.2 pg/mL, p=0.008 vs. placebo and p=0.007 vs. amlodipine) and TC (from 4.3±0.5 to 3.6±0.4 mmol/L, p=0.008 vs. placebo and vs. amlodipine). HOMA-IR changes significantly correlated with TNF-α changes (r=0.38, p<0.05) during combination but not during amlodipine monotherapy. In normocholesterolemic, obese hypertensive patients, the amlodipine-atorvastatin combination decreased inflammatory markers and IR more than amlodipine monotherapy and produced a greater SBP and DBP reduction.     

Efficacy and safety of isradipine in hypertension

Of the calcium channel blocking drugs, only verapamil is approved in the United States for treatment of hypertension. Isradipine is a 1,4-dihydropyridine calcium blocker that may be given on a twice-daily basis. It causes peripheral vasodilation with minimal cardiodepressant activity. We undertook a double-blind, parallel group randomized, multicenter study of 203 hypertensive subjects to examine the efficacy and safety of isradipine in treatment of hypertension. Subjects were given 0, 2.5, 5, 7.5, or 10 mg isradipine twice daily for up to 5 weeks. There was a significant dose-response relationship between isradipine dose and decrease in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Isradipine 15 mg/day reduced supine pressure by 16/15 mm Hg in patients with starting DBP less than 105 mm Hg and by 38/22 mm Hg in those with starting DBP greater than or equal to 105 mm Hg. There was no significant orthostatic fall in blood pressure at any dose. Heart rate (HR) increased on an average by only a maximum of four beats/min. The drug was slightly more effective in the elderly in the standing position than in the young in the standing position. Adverse effects were mild, and only six patients were discontinued from the study because of adverse effects. Isradipine appears to be a safe, effective drug in monotherapy of hypertension at a wide range of patient ages.     

氯沙坦与氨氯地平的降压疗效及对左室肥厚逆转作用的比较

目的 :评价并比较氯沙坦及氨氯地平的降压疗效及对左室肥厚的逆转作用。方法 :12 0例高血压病伴左室肥厚病人随机分为 2组。氯沙坦组6 0例 ,给氯沙坦 2 5～ 50mg ,po ,qm。氨氯地平组6 0例 ,给氨氯地平 5～ 10mg ,po ,qm ;疗程均为 2 4wk。结果 :治疗 2 4wk后 ,氯沙坦组SBP和DBP下降差值分别为 (3.4± 1.7)kPa和 (2 .7± 0 .7)kPa ,氨氯地平组为 (3.2± 1.5)kPa和 (2 .2± 0 .9)kPa(均P<0 .0 1)。组间比较 ,氯沙坦组除偶测血压SBP外 ,DBP和 2 4h动态血压均较氨氯地平组下降显著 (P<0 .0 1)。2组室间隔厚度、左心室后壁厚度、左室心肌重量指数较治疗前显著改善 (P <0 .0 1)。结论 :氯沙坦与氨氯地平均能显著降压 ,并使左室肥厚逆转     

氯沙坦调节高血压大鼠血管重塑及其对p38MAPK信号蛋白表达的影响

目的研究血管紧张素Ⅱ受体-1阻断剂氯沙坦对肾性高血压大鼠血管重塑及其分裂原激活的蛋白激酶p38MAPK表达的影响。方法两肾一夹法复制肾血管性高血压大鼠(2K1C-RHR)模型;采用尾动脉套管法和颈动脉插管法测量大鼠血压,大血管(胸主动脉)苏木素-伊红(HE)染色进行形态学观察;治疗组采用氯沙坦灌胃治疗;反转录-聚合酶链反应和免疫印迹方法检测主动脉血管p38MAPK的表达。结果实验组大鼠和对照组(假手术组)普通饲料饲养6周,模型组血压为(158±7)mmHg,对照组血压为(104±11)mmHg;两组间差异有显著性(P<0.05);模型组大鼠胸主动脉内径增大,中层厚度增大,细胞层数略微增加。经氯沙坦治疗后,血压降为(132±9)mmHg,血管重塑现象氯沙坦治疗组较实验组明显改善;免疫印迹方法检测,重塑血管主动脉血管p38MAPK的表达增高,氯沙坦干预可以抑制其表达。结论氯沙坦可明显改善肾血管性高血压大鼠血管重塑,这种调节可能是通过阻断血管紧张素Ⅱ受体信号途径或调节p38MAPK表达而发挥作用。     

氯沙坦钾氢氯噻嗪片治疗老年原发性高血压的临床效果观察

目的分析老年原发性高血压患者应用氯沙坦钾氢氯噻嗪片治疗的效果。方法 96例老年原发性高血压患者,随机分为对照组和观察组,每组48例。对照组采用氢氯噻嗪片治疗,观察组采用氯沙坦钾氢氯噻嗪片治疗。比较两组患者治疗效果及治疗前后血压水平。结果观察组患者的治疗总有效率97.92%高于对照组的85.42%,差异具有统计学意义(P<0.05)。治疗前,两组患者的清晨收缩压(SBP)、舒张压(DBP)及24 h动态SBP、DBP水平比较差异无统计学意义(P>0.05);治疗后,两组患者的清晨SBP、DBP及24 h动态SBP、DBP水平均较治疗前降低,且观察组患者的清晨SBP(135.14±7.04)mm Hg(1 mm Hg=0.133 kPa)、DBP(86.53±6.78)mm Hg及24 h动态SBP(134.24±9.61)mm Hg、DBP(84.81±8.80)mm Hg低于对照组的(140.26±8.17)、(92.06±7.36)、(142.36±9.16)、(89.03±8.05)mm Hg,差异具有统计学意义(P<0.05)。结论老年原发性高血压患者应用氯沙坦钾氢氯噻嗪片治疗的效果比较好,可以明显改善血压水平,具有较高的应用价值。     

依那普利-氢氯噻嗪治疗原发性高血压的临床疗效

目的:研究依那普利-氢氯噻嗪治疗中国人原发性高血压的临床疗效、安全性和耐受性。方法:采用随机、双盲、平行对照临床试验。126例轻、中度原发性高血压[95mmHg≤平均坐位舒张压(DBP)<110mmHg,平均坐位收缩压(SBP)<180mmHg(1mmHg=0.133kPa)],口服安慰剂2wk后, DBP仍在95-110mmHg的病人,随机分为3组,A组口服依那普利-氢氯噻嗪(10mg:6.25mg),qd;B组口服依那普利-氢氯噻嗪(10mg:12.5mg),qd;C组口服依那普利10mg,qd,4wk后如DBP≥90mmHg,各组剂量均加倍,疗程为8wk。安慰剂期末和治疗2,4,6,8wk测量坐位、立位血压和心率,记录不良反应。结果:8wk末,A组DBP由(99±4)mmHg降至(83±6)mmHg,降低(15±4)mmHg, SBP降低(18±14)mmHg;B组DBP由(100±5)mmHg降至(83±6)mmHg,降低(16±7)mmHg, SBP降低(17±16)mmHg;C组DBP由(97.0±2.0)mmHg降至(89±8)mmHg,降低(8±8)mmHg, SBP降低(3±14)mmHg。各组内DBP与治疗前相比均有非常显著差异(P<0.01),A,B两组组间差异无显著意义(P>0.05),A,B两组降压幅度优于C组,组间比较差异显著(P<0.05)。A,B,C组降压总有效率分别为86％,83％及60％,A,B两组比较无显著差异,分别与C组比较差异显著,优于C组(P<0.05)。3组主要不良反应为咳嗽、干咳,组间比较发生率无显著差异。结论:依那普利-氢氯噻嗪治疗轻、中度原发性高血压疗效优于单药制剂,6.25mg与12.5mg氢氯噻嗪的复方制剂降压疗效相似,复方制剂和单药一样安全,且耐受性好。     

护理干预对老年患者截石位手术体位改变前后上下肢血压差影响的探讨

目的分析护理干预在老年截石位手术患者术后体位改变前后上下肢血压差中的效果。方法选取2010年10月～2013年10月行截石位手术的老年患者60例,观察组1（30例）采用被动式运动法护理干预,观察组2（30例）采用弹力绷带法,同时选取30例常规护理患者为对照组。对比三组患者术后双下肢放平前及放平后1、5、15min的收缩压（SBP）、舒张压（DBP）、心率（P）及平均动脉压（MAP）,体位改变前后上下肢SBP、DBP与MAP差值及并发症。结果观察组1、2SBP、DBP、P与MAP波动均小于比对照组,且观察组1波动小于观察组2;SBP、DBP与MAP在体位改变前后的差值均小于对照组,且观察组1差值小于观察组2;并发症发生率少于对照组,且观察组1少于观察组2（P〈0．05）。结论对老年截石位手术患者在术后采用被动式运动法进行护理干预,可有效减少体位改变前后上下肢的血压差,值得推广。     

Losartan and prevention of atrial fibrillation recurrence in hypertensive patients

The aim of the study was to evaluate the effect of losartan as compared with amlodipine, both associated with amiodarone, in preventing the recurrence of atrial fibrillation (AF) in hypertensive patients with a history of recent paroxysmal atrial fibrillation. Two hundred and fifty mild hypertensive (SBP > 140 mm Hg and/or DBP > 90 < 100 mm Hg) outpatients in sinus rhythm but with at least two ECG-documented episodes of symptomatic atrial fibrillation in the previous 6 months and in treatment with amiodarone were randomized to losartan or amlodipine and were followed up for 1 year. Clinic blood pressure (BP) and a 24-hour ECG was evaluated every month; the patients were asked to report any episode of symptomatic atrial fibrillation and to perform an ECG as early as possible. Two hundred and thirteen patients completed the study, 107 in the losartan group and 106 in the amlodipine group. After 12 months the SBP/DBP mean values were significantly reduced by both losartan (from 151.4/95.6 to 135.5/83.7 mm Hg, P < 0.001 versus baseline) and amlodipine (from 152.3/96.5 to 135.2/83.4 mm Hg, P < 0.001 versus baseline), with no difference between the two treatments. At least one ECG-documented episode of atrial fibrillation was reported in 13% of the patients treated with losartan and in 39% of the patients treated with amlodipine. The use of losartan in combination with amiodarone seems more effective than amlodipine/amiodarone combination in preventing new episodes of atrial fibrillation in hypertensive patients with recurrent atrial fibrillation. This might be related to possible favorable impact of angiotensin II receptor blockers (ARB) on the atrial electrical and structural remodeling in this type of patients.     

Antihypertensive Effect and Tolerability of Perindopril in Indian Hypertensive and Type 2 Diabetic Patients: 1-Year Randomised, Double-Blind, Parallel Study vs Atenolol

OBJECTIVE: This study compared the antihypertensive effect and acceptability of a perindopril-based group with that of an atenolol-based group in Indian hypertensive type 2 (non-insulin-dependent) diabetic patients. DESIGN AND SETTING: 100 ambulant patients aged between 35 and 69 years were recruited into this monocentric, randomised, double-blind study in two parallel groups for 1 year after a 1-month washout period on placebo. The setting was a tertiary care institution. PATIENTS: All patients had stable, essential hypertension between 95mm Hg and 115mm Hg, type 2 diabetes with glycosylated haemoglobin (HbA(1C)) <12%, and albuminuria between 300mg and 3.5g/24 hours. There were 50 patients per treatment group and two patient population groups were studied, intention-to-treat (ITT) and per-protocol (PP). The former constituted all patients, whilst the latter included those without major protocol deviation and who completed the 12-month study. INTERVENTIONS: The study drugs were perindopril 4 to 8mg once daily or atenolol 50 to 100mg once daily. In each group therapeutic adjustment was planned by doubling the dose and then by the addition of hydrochlorothiazide 25mg daily. Nifedipine 30 to 60mg daily was subsequently added if the desired drop in blood pressure was not obtained. The ITT group was analysed by Student's t-test, and a 2-way analysis of variance was performed for the PP population. MAIN OUTCOME MEASURES: A comparison of the control of hypertension, biochemical abnormalities, blood sugar and adverse effects was performed in the atenolol group versus the perindopril group. RESULTS: On single-dose therapy after 1 month 17 patients (60%) had normal blood pressure [diastolic blood pressure (DBP) 相似文献