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目的探讨将收缩压控制在140mmHg以下对1级高血压合并2型糖尿病80岁以上高龄老人尿微量白蛋白的影响。方法 1级高血压合并2型糖尿病伴尿微量白蛋白阳性老老年(≥80岁)门诊或住院患者70例,按就诊顺序随机分降压治疗组(35例)和常规治疗组(35例),降压治疗组在常规治疗的基础上加服厄贝沙坦(150mg/d),根据血压水平加用氨氯地平2.5～5.0mg/d,使血压平稳控制在120～140/60～80mmHg;常规治疗组仅常规治疗,常规治疗包括调脂(阿托伐他汀,10mg/d)、降糖等,不接受任何降压治疗。疗程6月。监测两组治疗前后血压、24h尿微量白蛋白、血钾、血肌酐结果。结果常规治疗组治疗前后血压、尿微量白蛋白、血肌酐差异无统计学意义(P>0.05)。降压治疗组血压较治疗前降低[收缩压(126.9±3.8)比(148.5±3.6)mmHg;舒张压(69.9±4.1)比(76.0±5.2)mmHg;P<0.01],降压治疗组尿微量白蛋白较治疗前降低[(63.1±15.6)比(130.8±35.3)mg/d,P<0.01],降压治疗组血肌酐较治疗前降低(P<0.05)。降压治疗组治疗前后收缩压差值与治疗前后尿微量白蛋白差值呈正相关(P<0.01)。两组治疗前后血钾比较,差异无统计学意义。结论以厄贝沙坦为基础的降压方案能改善1级高血压合并糖尿病的老老年患者的早期肾损害。
Objective To investigate the effect of systolic blood pressure below 140mmHg on urinary albumin in elderly patients over 80 years old with type 1 hypertension and type 2 diabetes mellitus. Methods A total of 70 outpatients or inpatients with type 1 hypertension and type 2 diabetes mellitus with microalbuminuria positive elderly (≥80 years old) were randomized to receive antihypertensive treatment (n = 35) and conventional treatment (n = 35) , Antihypertensive treatment group on the basis of conventional therapy plus Irbesartan (150mg / d), according to the blood pressure plus amlodipine 2.5 ~ 5.0mg / d, so that the blood pressure was controlled at 120 ~ 140/60 ~ 80mmHg ; Conventional treatment group only conventional treatment, routine treatment, including lipid-lowering (atorvastatin, 10mg / d), hypoglycemic, not under any antihypertensive treatment. June treatment. Before and after treatment to monitor blood pressure, 24h urinary albumin, serum potassium, serum creatinine results. Results Before and after treatment, blood pressure, urinary albumin, serum creatinine had no significant difference (P> 0.05). Blood pressure in the antihypertensive treatment group was lower than that before treatment (systolic blood pressure (126.9 ± 3.8) vs (148.5 ± 3.6) mmHg, diastolic blood pressure (69.9 ± 4.1) vs (76.0 ± 5.2) mmHg, P <0.01] Microalbuminuria was lower than that before treatment [(63.1 ± 15.6) vs (130.8 ± 35.3) mg / d, P <0.01]. The serum creatinine in hypotensive treatment group was lower than that before treatment (P <0.05). The difference of systolic blood pressure before and after treatment in antihypertensive treatment group was positively correlated with the difference of urine microalbumin before and after treatment (P <0.01). Before and after treatment, serum potassium, the difference was not statistically significant. Conclusion Irbesartan-based antihypertensive regimen improves early renal impairment in elderly patients with grade 1 hypertension and diabetes mellitus.