作者：王蓉，孙洁，范文辉，李倩

单位：

243000 安徽省马鞍山市人民医院 通信作者：李倩，E-mail：951227767@qq.com

单位（英文）：

Maanshan People's Hospital, Maanshan 243000, China Corresponding author: LI Qian, E-mail: 951227767@qq.com

关键词：

H型高血压; 非杓型高血压; 男性; 高龄; 阿利沙坦酯; 维生素B6; 药物服用时间;

关键词（英文）：

H-type hypertension; Non-dipper hypertension; Male; Advanced age; Allisartan isoproxil; Vitamin B6;Drug administration time

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2021.00.287

基金项目：

摘要：

背景H型高血压是我国较为常见的高血压类型之一,占原发性高血压病的75%,其高同型半胱氨酸血症可能导致患者血管内皮功能进一步恶化,而伴随的高龄、基础疾病等使单一降压药物难以达到满意的临床效果,高龄患者治疗需要考虑血压波动、血压节律变化等因素。因此,选择合适的药物和用药时间对该类患者进行治疗具有重要意义。目的探讨不同时间服用阿利沙坦酯和维生素B6对高龄男性非杓型H型高血压患者动态血压、昼夜节律及血管内皮功能的影响。方法选取马鞍山市人民医院2018年1月至2021年10月收治的高龄男性非杓型H型高血压患者106例,采用随机数字表法分为晨药组(n=53)和夜药组(n=53)。晨药组于每日上午8:00服用240 mg阿利沙坦酯联合10 mg维生素B6,夜药组于每日晚上20:00服用240 mg阿利沙坦酯联合10 mg维生素B6,两组均治疗4周。治疗前及治疗后两组患者均采用全自动动态血压监测仪监测昼间(凌晨6:00至晚上20:00)、夜间(晚上20:00至次日凌晨6:00)、24 h收缩压、舒张压,采用彩色多普勒超声诊断仪测定肱动脉血管内皮依赖性舒张功能(FMD),采用全自动生化分析仪测定患者血清同型半胱氨酸(Hcy)水平,统计两组患者杓型高血压转变率,治疗前及治疗后采用彩色多普勒超声心动图检测舒张末期室间隔厚度(IVST)、左心室后壁厚度(LVPWT)及左心室舒张末期内径(LVEDD)。结果治疗前,两组患者昼间收缩压、夜间收缩压、24 h收缩压、昼间舒张压、夜间舒张压、24 h舒张压、FMD、Hcy水平比较,差异无统计学意义(P> 0.05);治疗后,两组患者昼间收缩压、昼间舒张压、夜间舒张压、24 h舒张压、FMD比较,差异无统计学意义(P> 0.05);治疗后,夜药组患者夜间收缩压、24 h收缩压、血清Hcy水平低于晨药组(P <0.05)。治疗后夜药组出现杓型高血压29例(54.7%),晨药组出现杓型高血压13例(24.5%),夜药组患者杓型高血压发生率高于晨药组(P <0.05)。治疗前及治疗后,两组患者IVST、LVPWT、LVEDD比较,差异无统计学意义(P> 0.05)。结论夜间服用阿利沙坦酯联合维生素B6可有效纠正高龄男性非杓型H型高血压患者动态血压及昼夜节律,改善血管内皮功能,但不会加重患者左心室肥厚程度。

英文摘要：

【Abstract】　Background H-type hypertension is one of the common types of hypertension in China, accounting for75% of primary hypertension. Its hyperhomocysteinemia may lead to further damage to vascular endothelium function in patients.With the influence of old age and basic diseases, it is difficult for a single antihypertensive drug to achieve clinical treatmenteffect, and the treatment of elderly patients needs to consider factors such as blood pressure fluctuation and blood pressure rhythmchange. Therefore, the selection of appropriate medication time and drugs is of great significance to the treatment of this kind ofpatients. Objective To investigate the effects of allisartan isoproxil combined with vitamin B6 at different times on ambulatoryblood pressure, circadian rhythm and vascular endothelial function in elderly male patients with non-dipper H-type hypertension.MethodsOne hundred and six elderly male patients with non-dipper H-type hypertension in Maanshan People's Hospital fromJanuary 2018 to October 2021 were randomly divided into morning medication group (n=53) and night medication group (n=53).The morning medication group took allisartan isoproxil (240 mg) combined with vitamin B6 (10 mg) at 8 o'clock every day. Thenight medicine group took allisartan isoproxil (240 mg) combined with vitamin B6 (10 mg) at 20 o'clock every day. Both groups weretreated for 4 weeks. Before and after treatment, the systolic and diastolic blood pressure in the daytime (6：00 am to 20：00 pm) ,at night (20：00 pm to 6：00 am) and 24 hours were monitored by automatic ambulatory blood pressure monitor. The brachialartery endothelium-dependent flowing-mediated dilation (FMD) was measured by color Doppler ultrasound diagnostic instrument,the level of serum homocysteine (Hcy) was measured by automatic biochemical analyzer. Incidence of dipper hypertension wasrecorded between the two groups. Interventricular septal thickness (IVST) , left ventricular posterior wall thickness (LVPWT) andleft ventricular end diastolic dimension (LVEDD) were measured by color Doppler echocardiography before and after treatment.Results Before treatment, there was no significant difference in the daytime systolic blood pressure, nighttime systolic bloodpressure, 24 h systolic blood pressure, daytime diastolic blood pressure, nighttime diastolic blood pressure, 24 h diastolic bloodpressure, FMD and serum Hcy level between the two groups (P> 0.05) . After treatment, there was no significant difference indaytime systolic blood pressure, daytime diastolic blood pressure, nighttime diastolic blood pressure, 24 h diastolic blood pressureand FMD between the two groups (P> 0.05) . After treatment, the nighttime systolic blood pressure, 24 h systolic blood pressureand the serum level of Hcy in the night medication group were lower than those in the morning medication group (P< 0.05) .After treatment, 29 dipper blood pressure cases (54.7%) occurred in the night medication group and 13 cases (24.5%) in themorning medication group. The incidence of dipper hypertension in the night medication group was higher than that in the morningmedication group (P< 0.05) . There was no significant difference in IVST, LVPWT and LVEDD between the two groups beforeand after treatment (P> 0.05) .Conclusion Taking allisartan isoproxil combined vitamin B6 at night can effectively correct theambulatory circadian rhythm blood pressure in elderly male patients with non-dipper H-type hypertension, and reduce the levelof serum Hcy. It does not aggravate the degree of left ventricular hypertrophy in patients.

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