摘要
目的探讨不同治疗依从性对高血压病患者临床终点事件的影响。方法选择轻、中度高血压病患者853例，入选患者经安慰剂洗脱2周和氢氯噻嗪（HCTZ）导入6周后随机给予HCTZ 12．5mg／d或HCTZ 12．5mg／d＋螺内酯20mg／d或HCTZ 12．5mg／d＋卡托普利25mg2次／d。根据患者的依从性分为依从组和非依从组。治疗期间每月随访1次，监测血压，记录终点事件，每年进行1次血生化指标检测。随访4年。结果（1）第4年时依从组和非依从组的收缩压与基线值比较分别降低（19．4±20．6）mmHg（1mmHg=0．133kPa）和（7．3±18．2）mmHg，舒张压与基线值比较分别降低（10．7±13．5）mmHg和（3．5±10．2）mmHg。依从组血压与基线值和非依从组血压比较均降低（P〈0．001）。（2）第4年时依从组血清尿素氮、肌酐、尿酸水平较基线值升高；血清K、总胆固醇、低密度脂蛋白胆固醇水平较基线值低；两组间血生化值比较，依从组血清尿素氮、尿酸水平较非依从组高，而血清K、总胆固醇水平较非依从组降低。（3）第4年时依从组发生临床终点事件10例（致死性2例，非致死性8例）。非依从组发生临床终点事件28例（致死性7例，非致死性21例）。第4年时依从组无事件率高于非依从组（P〈0．05）。结论在依从性良好的情况下，以噻嗪类利尿剂作为基础降压药物长期治疗高血压不但能够有效降低患者血压，还能减少高血压病患者临床终点事件的发生．
Objective To explore the impact of patient compliance on the long-term outcomes in hypertensive patients receiving hydrochlorothiazide（HCTZ） based combination therapy with spironolaetone or captopril. Methods A total of 853 patients with mild to moderate hypertension were recruited and randomly divided into HCTZ group （HCTZ 12. 5 mg q. d ）, spironolactone group （HCTZ 12. 5 mg q. d and spironolactone 20 mg q. d）, and captopril group （ HCTZ 12. 5 mg q. d and captopril 25 mg bid） after 2-week placebo washout period and 6-week loading period for HCTZ. Since the efficacy of combination therapy was proven to be better than monotherapy 1 year after therapy beginning, patients in HCTZ group were randomly assigned to spironolactone group or captopril group. The patients were followed up for 4 years. Patients were divided to compliance （n = 424 ） or non-compliance group （n = 429 ） according test drug taking questionnaire. During the follow-up time, the blood pressure and the outcomes were recorded monthly, and blood biochemical parameters were determined once a year. Results At the end of follow up, incidence of cardio-cerebral vascular events was significantly lower in compliance group （2 fatal, 8 non-fatal） than that in noncompliance group （7 fatal, 21 non-fatal, P 〈0. 05）. Systolic blood pressure [ - （ 19. 4 ± 20. 6）mm Hg, 1 mm Hg =0. 133 kPa] and diastolic blood pressure[ - （10. 7 ± 13.5）mm Hg] were significantly reduced compared values at baseline and noncompliance group （all P 〈 0. 001 ） while the reduction did not reach statistically significance in noncompliance group[ - （7.3 ± 18.2）mm Hg and - （3.5 ± 10. 2）mm Hg, all P 〉 0.05 vs. baseline]. The serum BUN, Cr and UA levels in the compliance group were significantly higher and the serum K^＋ , CHO, LDL-C level were significantly lower than baseline values. The serum BUN, UA levels in the compliance group were significantly higher while the serum K ^＋ , cholesterol levels were significantly lower than those in the noncompliance group （all P 〈 0. 05 ）. Conclusions This study indicates that patient compliance could affect the long-term outcome and antihypertensive efficacy in hypertensive patients receiving HCTZ based combination therapy with spironolactone or captopril.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2008年第12期1078-1082,共5页
Chinese Journal of Cardiology
关键词
高血压
病人依从
治疗结果
Hypertension
Patient compliance
Treatment outcome
