作者：尹絮，宋雨，吴东彬

单位：

安徽省阜阳市肿瘤医院心血管内科

Units：

Department of Cardiology, Fuyang Tumor Hospital, Fuyang 236000, China

关键词：

高血压; 难治性高血压; 厄贝沙坦; 苯磺酸氨氯地平; 动脉粥样硬化; 负性情绪;

Keywords：

Hypertension; Refractory hypertension; Irbesartan; Amlodipine besylate; Atherosclerosis; Negative emotion

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.103

Funds：

摘要：

目的 观察厄贝沙坦联合苯磺酸氨氯地平对难治性高血压患者降压效果、动脉粥样硬化及负性情绪的影响。方法 收集阜阳市肿瘤医院2020年3月至2022年8月收治的110例难治性高血压患者，根据治疗方法不同将其分为常规组和联合组，每组55例。两组患者均给予氢氯噻嗪片治疗，在此基础上，常规组患者给予厄贝沙坦片联合硝苯地平缓释片治疗，联合组给予厄贝沙坦片联合苯磺酸氨氯地平片治疗。两组患者均连续治疗8周。比较两组患者治疗前后血压和实验室检查指标[血清血管性血友病因子(vWF)、降钙素基因相关肽(CGRP)、TNF-α、同型半胱氨酸(Hcy)]、颈动脉内膜中层厚度(IMT)、汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分]及治疗期间不良反应发生率。结果 治疗后，两组24 h收缩压、24 h舒张压、日间收缩压、日间舒张压、夜间收缩压、夜间舒张压分别低于本组治疗前，且联合组低于对照组(P<0.05)。治疗后，两组血清CGRP分别高于本组治疗前，血清vWF、TNF-α、Hcy分别低于本组治疗前，颈动脉IMT分别小于本组治疗前，且联合组血清CGRP高于常规组，血清vWF、TNF-α、Hcy低于常规组，颈动脉IMT小于常规组(P<0.05)。治疗后，两组HAMA评分、HAMD评分分别低于本组治疗前，且联合组低于常规组(P<0.05)。治疗期间，联合组不良反应发生率为9.1%(5/55)，与常规组的5.5%(3/55)比较，差异无统计学意义(χ2=0.539,P=0.463)。结论 厄贝沙坦联合苯磺酸氨氯地平能有效降低难治性高血压患者的24 h血压、日间血压及夜间血压，减轻患者动脉粥样硬化程度及焦虑、抑郁程度，且未增加药物相关不良反应。

Abstract：

Objective To observe the effect of irbesartan combined with amlodipine besylate on hypertensive effect, atherosclerosis and negative emotion in patients with refractory hypertension. Methods A total of 110 patients with refractory hypertension admitted to Fuyang Tumor Hospital from March 2020 to August 2022 were collected and divided into conventional group and combined group according to different treatment methods, with 55 cases in each group. Both groups were treated with hydrochlorothiazide tablets, then the conventional group was treated with irbesartan tablets combined with nifedipine sustainedrelease tablets, and the combined group was treated with irbesartan tablets combined with amlodipine besylate tablets. Both groups were continuously treated for 8 weeks. Blood pressure, laboratory examination indicators [serum levels of von willebrand factor (vWF) , calcitonin gene-related peptide (CGRP) , tumor necrosis factor-α (TNF-α) and homocysteine (Hcy) ] , carotid intima-media thickness (IMT) , Hamilton Anxiety Scale (HAMA) score, Hamilton Depression Scale (HAMD) score before and after treatment and the incidence of adverse reactions during the treatment were compared between the two groups. Results After treatment, 24 h systolic blood pressure, 24 h diastolic blood pressure, daytime systolic blood pressure, daytime diastolic blood pressure, nighttime systolic blood pressure and nighttime diastolic blood pressure in conventional group and combined group were lower than those before treatment, respectively, and those of combination group were lower than those of control group (P < 0.05) . After treatment, serum CGRP in conventional group and combined group was higher than that before treatment, serum vWF, TNF-α and Hcy were lower than those before treatment, carotid IMT was lower than that before treatment, respectively (P < 0.05) . After treatment, serum CGRP in combined group was higher than that in conventional group, serum vWF, TNF-α and Hcy were lower than those in conventional group, carotid IMT was smaller than that in conventional group (P < 0.05) . After treatment,HAMA score and HAMD score in conventional group and combined group were lower than those before treatment, respectively, and those of combined group were lower than those of conventional group (P < 0.05) . There was no significant difference in the incidence of adverse reactions during the treatment [9.1% (5/55) vs 5.5% (3/55) , χ2 =0.539, P=0.463] . Conclusion Irbesartan combined with amlodipine besylate can effectively reduce 24 h blood pressure, daytime blood pressure and nighttime blood pressure in patients with refractory hypertension, reduce the degree of atherosclerosis, anxiety and depression, and do not increase drug-related adverse reactions.

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