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目的探讨氨氯地平与氢氯噻嗪联合应用对老年高血压的治疗效果及对平稳降压与改善靶器官功能的影响。方法选取本院2013年2月-2015年10月收治的91例高血压老年患者,依据治疗方法不同分为对照组45例,研究组46例。对照组予以氢氯噻嗪治疗,研究组予以氨氯地平与氢氯噻嗪联合治疗。统计两组临床效果、不良反应情况,对比治疗前后两组患者血压变化情况[脉压差、24 h收缩压(SBP)、舒张压(DBP)的平均血压及血压变异率]、相关靶器官参数[左心室心肌重量指数(LVMI)、左心室舒张早期充盈峰值流速/心房收缩期充盈峰值流速(E/A)、左心室射血分数(EF)、24 h肌酐清除率(Ccr)、24 h尿微量白蛋白(MAU)水平]。结果治疗前,两组脉压差、24 h SBP、DBP平均血压及血压变异率差异均无统计学意义(均P>0.05)。治疗24 w后,与对照组相比,研究组脉压差明显升高,24 h SBP、DBP平均血压及血压变异率均显著降低,差异有统计学意义(均P<0.05);研究组临床总有效率为97.83%(45/46),远高于对照组的82.22%(37/45),差异有统计学意义(P<0.05);治疗前,两组LVMI、E/A、EF、Ccr、MAU水平差异均无统计学意义(均P>0.05);治疗24 w后,与对照组相比,研究组LVMI、MAU水平显著降低,E/A、EF及Ccr水平明显升高,差异均有统计学意义(均P<0.05);研究组不良反应发生率为13.05%(6/46),与对照组的8.88%(4/45)比较差异无统计学意义(P>0.05)。结论对老年高血压患者联合应用氢氯噻嗪与氨氯地平治疗效果更为显著,可达到平稳降压目的,同时还可改善靶器官功能,安全性较高,在临床治疗中具有重要意义。
Objective To investigate the therapeutic effect of amlodipine and hydrochlorothiazide combined with hydrochlorothiazide on senile hypertension and its effect on steady-state hypotension and target organ function improvement. Methods A total of 91 hypertensive elderly patients admitted from February 2013 to October 2015 in our hospital were divided into control group (n = 45) and study group (n = 46) according to different treatment methods. The control group was treated with hydrochlorothiazide, the study group was treated with amlodipine and hydrochlorothiazide. The clinical effects and adverse reactions were compared between the two groups. The changes of blood pressure (systolic blood pressure, systolic blood pressure at 24 h, mean blood pressure at diastolic blood pressure and blood pressure variability) were compared between the two groups before and after treatment. The target organ parameters [LVMI, early peak filling velocity of left ventricular diastolic filling / peak filling velocity of atrial systolic velocity (E / A), left ventricular ejection fraction (EF), 24 h creatinine clearance rate (Ccr), 24 h Urinary microalbumin (MAU) levels]. Results Before treatment, there was no significant difference in pulse pressure difference, 24 h SBP, DBP mean blood pressure and blood pressure variability (all P> 0.05). After 24 weeks of treatment, compared with the control group, the study group pulse pressure increased significantly, 24 h SBP, DBP mean blood pressure and blood pressure variability were significantly lower, the difference was statistically significant (P <0.05) The total effective rate was 97.83% (45/46), which was much higher than that of the control group (82.22%, 37/45), the difference was statistically significant (P <0.05) There was no significant difference in Ccr and MAU levels between the two groups (all P> 0.05). Compared with the control group, the levels of LVMI and MAU were significantly decreased and the levels of E / A, EF and Ccr were significantly increased (All P <0.05). The incidence of adverse reactions in the study group was 13.05% (6/46), which was not significantly different from that in the control group (8.88%, 4/45) (P> 0.05). Conclusions The combination therapy of hydrochlorothiazide and amlodipine in senile patients with hypertension is more effective and can achieve the goal of steady blood pressure lowering. At the same time, it can improve the function of target organs and has higher safety. It is of great significance in clinical treatment.