目的 探討氫氯噻嗪聯(lián)合纈沙坦治療老年高血壓的臨床療效。方法 2011年7月—2014年6月上海交通大學(xué)醫(yī)學(xué)院附屬新華醫(yī)院收治的老年原發(fā)性高血壓患者96例，隨機(jī)分為對(duì)照組（48例）和治療組（48例），對(duì)照組口服纈沙坦膠囊80 mg/d。治療組口服氫氯噻嗪片12.5 mg/d，其他同對(duì)照組。兩組均持續(xù)治療2個(gè)月。治療后，評(píng)價(jià)兩組的臨床療效，同時(shí)比較兩組治療前后收縮壓（SBP）、收縮壓變異度（SBPV）、舒張壓（DBP）、舒張壓變異度（DBPV）、血壓晨峰（MBPS）的控制率、一氧化氮、內(nèi)皮素的變化。結(jié)果 治療組和對(duì)照組的總有效率分別為97.92%、83.33%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者平均SBP、SBPV、DBP、DBPV、內(nèi)皮素均較治療前顯著降低，一氧化氮水平顯著升高，同組治療前后差異有統(tǒng)計(jì)學(xué)意義（P<0.05），且治療后治療組這些觀察指標(biāo)的改善程度優(yōu)于對(duì)照組，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療組MBPS控制率為93.75%，對(duì)照組為81.25%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 氫氯噻嗪聯(lián)合纈沙坦治療老年高血壓具有較好的臨床療效，可顯著降低患者血壓和血壓晝夜變異度，可能與調(diào)節(jié)內(nèi)皮一氧化氮和內(nèi)皮素水平有關(guān)。

Objective To investigate the effect of hydrochlorothiazide combined with valsartan in the treatment of elderly hypertension. Methods Collecting 96 cases suffered from elderly hypertension from July 2011 to June 2014 in Xinhua Hospital Affiliated to School of Medicine of Shanghai Jiaotong University, which were randomly divided into treatment (48 cases) and control (48 cases) groups. The patients in the control group were po administered with Valsartan Capsule, 80 mg/d, while the patients in the treatment group were po administered with Hydrochlorothiazide Tablets, 12.5 mg/d, and other treatment was the same as the control group. The patients in the two groups were treated for 2 months. After the treatment, the treatment efficacy was evaluated, while SBP, SBPV, DBP, DBPV, control rate of MBPS, NO, and endothelin were compared between the two groups. Results The efficacies in the control and treatment groups were 97.92% and 83.33%, respectively, and there were differences between the two groups (P < 0.05). After the treatment, SBP, SBPV, DBP, DBPV, and endothelin in the two groups were significantly reduced, while NO were significantly increased, and the difference was statistically significant before and after the treatment in the same group (P < 0.05). And after the treatment, those observational indexes were improved better than those in the control group, and there was significant difference between the two groups (P < 0.05). The control rate of MBPS in the treatment group was 93.75%, and in the control group was 81.25%, and there was significant difference between the two groups (P < 0.05). Conclusion Hydrochlorothiazide combine with valsartan has a good clinical effect in the treatment of elderly hypertension, and can significantly reduce the blood pressure and circadian variation of blood pressure, which may be associated with regulating the level of NO and endothelin.

國(guó)家自然科學(xué)基金資助項(xiàng)目（81000037）