Department of Nephrology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey.
Hypertens Res. 2012 Nov;35(11):1111-7. doi: 10.1038/hr.2012.95. Epub 2012 Jul 12.
In addition to high blood pressure (BP), BP variability has recently also been shown to increase cardiovascular events. The purpose of this study was to compare the effect of a fixed-dose combinations (FDCs) of valsartan/amlodipine and a valsartan- and amlodipine-free drug combination on 24-h BPV. A total of 85 patients aged 18 or older and with no exclusion criteria were enrolled; of the 85 patients, 43 used the FDCs valsartan/amlodipine (160/10 mg) and 42 used a free drug combination of valsartan 160 mg and amlodipine 10 mg. Twenty-four hour ambulatory BP monitoring (ABPM) was performed after office BP measurements. Mean hourly BP, all-day BP reduction, trough/peak (T/P) ratio and Smoothness Index (SI) were calculated from the 24-h ABPM data. These were calculated separately for all-day, daytime, nighttime and early morning periods. The hourly mean diastolic BP (DBP) at 0800 hours in the FDCs group was significantly higher compared with the free drug combination group in the 24-h BP chronogram (P=0.041). Decreases in the all-day, daytime, nighttime and early morning systolic BP (SBP) and DBP in patients using a free drug combination were significantly greater compared with the FDC group. The SI and T/P ratio of the all-day, daytime and nighttime systolic and diastolic were also significantly higher compared with the FDC group. In addition, nighttime DBP reduction and the SI of DBP were lower in the diabetic patients. A free drug combination of amlodipine and valsartan provides more effective and smooth SBP and DSP control compared with FDCs.
除了高血压（BP），BP 变异性最近也被证明会增加心血管事件。本研究的目的是比较缬沙坦/氨氯地平固定剂量复方和缬沙坦/氨氯地平无固定剂量复方对 24 小时 BPV 的影响。共纳入 85 例年龄在 18 岁及以上且无排除标准的患者；85 例患者中，43 例使用 FDCs 缬沙坦/氨氯地平（160/10mg），42 例使用缬沙坦 160mg 和氨氯地平 10mg 的自由药物组合。在办公室血压测量后进行 24 小时动态血压监测（ABPM）。从 24 小时 ABPM 数据中计算出平均每小时 BP、全天 BP 降低、谷峰（T/P）比和平滑指数（SI）。这些分别在全天、白天、夜间和清晨时段进行计算。FDC 组在 24 小时 BP 时间图中 0800 小时的平均每小时舒张压（DBP）明显高于自由药物组合组（P=0.041）。与 FDC 组相比，使用自由药物组合的患者全天、白天、夜间和清晨的收缩压（SBP）和舒张压（DBP）下降幅度显著更大。全天、白天、夜间和清晨收缩压和舒张压的 SI 和 T/P 比也明显高于 FDC 组。此外，夜间 DBP 降低和 DBP 的 SI 在糖尿病患者中较低。与 FDC 相比，氨氯地平和缬沙坦的自由药物组合可更有效地控制 SBP 和 DSP。
