初始联合治疗策略对高血压患者的疗效及肾功能的影响

【目的】探讨初始小剂量氨氯地平分别与复方阿米洛利和替米沙坦联合治疗高血压痛的效果及对肾功能的影响。【方法】302例50～79岁伴心血管病危险因素的原发性高血压患者随机分为A、B两组，起始治疗A组给予小剂量氨氯地平（2．5mg／d）＋复方阿米洛利（半片／d），含阿米洛利1．25mg，氢氯嘧嗪12．5mg；B组给予氨氯地平＋替米沙坦（40mg／d）。二周后根据血压调整剂量，随访治疗一年，观察两种联合治疗方案对高血压患者的降压幅度、血压控制率、不良反应以及对血肌酐和内生肌酐清除率的影响。【结果】治疗前后A组与B组血压均显著降低，分别从（157．1±12．0）／（91．1±9．4）mmHg降至（128．1±10．3）／（76．6±8．0）mmHg和（156．4±13．6）／（91．2±9．5）mmHg降至（131．5±12．3）／（77．3±9．2）mmHg，P〈0．05；血压控制率分别为87．1％和76．5％（P=0．024）；B组血肌酐较治疗前降低（85．15±21．25）μmmol／Lvs．（82．70±20．21）μmmol／L，P=0．001]。【结论】两种联合治疗方案均可以显著降低血压，初始联合治疗可以显著提高血压控制率；联合方案中配伍替米沙坦可能提供降压外的肾脏保护作用。

Effect of Initial Combination Therapy for Hypertension and and Renal Function in Hypertensive Patients

Objective]To evaluate the effects of initial combination therapy with low dose amlodipine and amiloride or telmisartan for hypertensions and its impact on renal function in hypertensive patients. Methods] A total of 302 hypertensive patients aged 50-79 years with cardiovascular risk factors were included. Patients were randomly divided into Group A which received low-dose amlodipine（2.5mg/d） plus compound amiloride （1.25 mg amiloride and 12.5 mg hydrochlorothiazide） and Group B which received low-dose amlodipine（2.5 mg/d） plus telmisartan（40mg/d）. Blood pressures, side effects, serum creatinine and endogenous creatinine clearance rate were observed during 1-year follow up. Results]After 1 year treatment, mean blood pressure in Group A and B were reduced from 157. 1±12.0/91.1±9.4mmHg and 156.4± 13.6 /91.2±9.5mmHg to 128.1±10.3/76.6±8.0 mmHg and 131.5± 12.3/77.3±9.2mmHg （P〈0.05）, respectively. Blood pressure control rate was 87.1% and 76.5% in Group A and B, respectively（ P =0. 024）. The serum creatinine level decreased from 85.15±21. 25μmmol/L to 82.70±20.21μmmol/L（ P =0. 001） after treatment in Group B. Conclusion]Initial low-dose andodipine-based antihypertensive combination regimens can significantly decrease blood pressure. Telmisartan in the combination regimens may also provide renal protection.