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目的评价在血管紧张素转化酶抑制剂、钙离子拮抗剂和利尿剂方案上联合小剂量安体舒通治疗顽固性高血压的疗效。方法将本院112例符合顽固性高血压诊断标准的患者随机分为对照组(n=56)和试验组(n=56),两组均服用硝苯地平控释片、贝那普利和双氢克尿噻片,对照组加服卡维地洛12.5-50mg/d,试验组加服安体舒通20-40mg/d,两组疗程均为8周。结果随机、双盲治疗8周末,试验组SeSBP下降值为(14.6±2.42)mmHg、SeDBP下降值为(9.6±1.53)mmHg、血压控制率为80.3%;对照组SeSBP下降值为(10.4±2.18)mmHg、SeDBP下降值为(7.2±1.79)mmHg、血压控制率为53.6%,P值分别为0.028、0.079和0.003。与对照组相比,试验组治疗后血K+、血肌酐明显升高(0.41±0.05比0.11±0.07,7.96±2.26比0.89±0.02;P值分别为0.001和0.003),血Na+变化两组无统计学差异(P=0.169)。结论联合小剂量安体舒通治疗顽固性高血压可以有效降低患者的收缩压,提高血压控制率,但同时应注意密切监测患者血钾及血肌酐水平。
Objective To evaluate the efficacy of combination of small doses of spironolactone on patients with refractory hypertension on angiotensin converting enzyme inhibitors, calcium channel blockers and diuretic regimens. Methods One hundred and twelve patients with refractory hypertension were randomly divided into control group (n = 56) and experimental group (n = 56). Nifedipine controlled release tablets, Hydrochlorothiazide tablets, the control group plus serving carvedilol 12.5-50mg / d, the test group plus spironolactone 20-40mg / d, the two groups were treated for 8 weeks. Results At the end of the randomized, double-blind treatment for 8 weeks, the SeSBP decreased (14.6 ± 2.42) mmHg, the SeDBP decreased (9.6 ± 1.53) mmHg and the blood pressure controlled rate was 80.3% ) mmHg, SeDBP decreased (7.2 ± 1.79) mmHg, blood pressure control rate was 53.6%, P values were 0.028,0.079 and 0.003 respectively. Compared with the control group, blood K + and serum creatinine were significantly increased (0.41 ± 0.05 vs. 0.11 ± 0.07, 7.96 ± 2.26 vs. 0.89 ± 0.02; P = 0.001 and 0.003, respectively) Statistical difference (P = 0.169). Conclusions The combination of small doses of spironolactone in the treatment of intractable hypertension can effectively reduce the systolic blood pressure and improve the blood pressure control rate. At the same time, we should pay close attention to the monitoring of serum potassium and serum creatinine level.