高血压患者生活质量及药物干预影响随机双盲研究(1026例报告) 被引量：18

Impacts of Antihypertensive Drugs on Quality of Life, A Prospective, Randomized, Double-blind Study

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摘要背景：随医学科学进展，各种治疗对患者生活质量的影响日益受到关注．改善高血压患者生活质量为降压治疗主要目的之一．国内外尚少采用随机双盲方法，并以正常人为对照，在大系列人群中对新一代降压药物及联合用药对患者生活质量影响的评价．方法：随机双盲并行研究１０２６例高血压患者，经二周安慰剂洗脱后，按年龄分层后随机分为６组：卡托普利组（卡组）１７１例，平均５６ｍｇ／日；氨酰心安组（氨组）１６８例，平均剂量４２ｍｇ／ｄ；尼群地平组（尼组）１７２例，平均剂量２３ｍｇ／ｄ；卡氨组１７１例，卡４５ｍｇ／日＋氨２６ｍｇ／ｄ；尼氨组１７３例，尼１８ｍｇ／ｄ＋氨２６ｍｇ／ｄ；卡尼组１７１例，卡４５ｍｇ／ｄ＋尼１８ｍｇ／ｄ。观察时间６月，观察内容包括血压、心率、副作用等指标。采用问卷自答的方法，对高血压患者治疗前后生活质量进行评定，并以６００例正常人为对照。结果：本研究发现单一用药降压平均达标率为５４．８％，尼组最好，卡组最低。联合用药达标率均高于单用，平均为７１．２％，尼氨组最好７８．８％，卡尼组次之７０．６％。高血压患者总体生活质量较正常人有不同程度降低，平均下降２．９０％，生活质量不同指标受损程度从大到小依次为? Objective: To campare the antihypertensive ef- fects of single drug or combined medication of nitrendipine, atenolol and captopril on the quality of life (QOL) of hypertensives. Methods:A prospective, randomized, double-blind study was performed on 1026 hypertensive patients of both sexes, aged 40-79 years with a blood pressure (BP)≥140/90 mmHg and M220/130 mmHg. Patients were randomly allocated to take one of the following regimen for 6 months: ( 1 ) Captopril group 56 mg/d average (n = 171 ); (2 ) Atenolol group average 42 mg/d (n = 168) ; (3 )Nitrendipine group 23 mg/d average (n = 172); (4 )Captopril 45 mg/d+Atenolol 26 mg/d group (n = 171 ); (5 )Nitrendipine 18 mg/d+Atenolol 26 mg/d group (n = 173); (6)Nitrendipine 18 mg/d+Captopril 45 mg/d group (n = 173). The BP, HR and side effect were observed. All patients were asked to answer 6 serial questions referring to quality of life(QOL) on a self- determining inquiring sheet before and after the treatment. Six-hundred age-matched normotensive subjects without chronic diseases served as control. Results: Normotensive subjects appeared to have a better QOL in all respects than hypertensive patients in the pretreatment assessment, especially in emotions (P < 0. 05 ), well-being and feelings (P<0. 05),sexual activity and sleeping (P < 0. 05 ), and total scores of QOL (P < 0. 05 ). All treatment groups except nitrendipine showed an improvement of QOL after the treatment groups. Furthermore, total scores of QOL indicated that the QOL in all combined medication groups were improved much better than in single drug groups. Among three combined medication groups, captopril plus nitrendipine group showed a better QOL status compared to nitrendipine + atenolol or captopril +atenolol(P<0. 01). No significant difference in QOL was found between the latter two groups (P < 0. 05 ). Among the single drug groups, atenolol had a better score in cognition (P<0. 01) and emotion (P<0. 01) than those of captopril or nitrendipine group. The rate of improvement of QOL in patie