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目的:比较小剂量氢氯噻嗪对不同盐敏感危险分层的高血压患者的降压效果。方法:入选原发性高血压患者91例,根据动态血压结果,将患者分为3组:高风险组、中间风险组与低风险组。各组随机给予联合12.5mg氢氯噻嗪和不联合氢氯噻嗪的治疗方案,8周后复查动态血压,比较各组内及组间的降压效果。结果:与未联合氢氯噻嗪组相比,低风险组内血压与心率无明显变化(P>0.05);中间风险组24h平均收缩压明显下降(P=0.01);高风险组24h平均收缩压、24h平均舒张压、日间平均舒张压、夜间平均收缩压及舒张压明显下降(P<0.05)。联合氢氯噻嗪治疗组中,高风险组24h平均收缩压、24h平均舒张压、夜间平均收缩压、夜间平均舒张压血压下降幅度明显高于低风险组及中间风险组(P<0.01)。结论:根据动态血压结果,对原发性高血压患者进行盐敏感性风险分层,对是否优先选择联合利尿剂的降压治疗方案具有一定的指导意义。
OBJECTIVE: To compare the antihypertensive efficacy of low-dose hydrochlorothiazide for hypertensive patients with different salt-sensitive risk strata. Methods: Ninety-one patients with essential hypertension were enrolled. According to the results of ambulatory blood pressure, the patients were divided into three groups: high-risk group, intermediate risk group and low-risk group. All patients were randomized to receive combined treatment with 12.5 mg hydrochlorothiazide and no hydrochlorothiazide. The ambulatory blood pressure was reviewed after 8 weeks and the antihypertensive effect was compared between groups. Results: Compared with no hydrochlorothiazide group, there was no significant difference in blood pressure and heart rate (P> 0.05) between the low-risk group and the intermediate-risk group (P = 0.01); mean systolic blood pressure Mean diastolic blood pressure, daytime mean diastolic blood pressure, nighttime mean systolic blood pressure and diastolic blood pressure decreased significantly (P <0.05). Combined hydrochlorothiazide treatment group, high-risk group 24h mean systolic blood pressure, 24h mean diastolic blood pressure, nighttime average systolic blood pressure, nighttime mean diastolic blood pressure decreased significantly higher than the low-risk group and the intermediate risk group (P <0.01). Conclusions: Based on the results of ambulatory blood pressure, risk stratification of salt sensitivity in patients with essential hypertension is of guiding significance for the hypothesis that antihypertensive treatment should be given priority to in combination with diuretics.