Rayner Brian
Kidney and Hypertension Research Unit, University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa,
Pragmat Obs Res. 2019 Jan 22;10:9-14. doi: 10.2147/POR.S186070. eCollection 2019.
To describe the efficacy of a stratified approach on automatic office blood pressure (BP), 24-hour ambulatory BP, and BP variability (BPV) in treatment-naïve patients with systolic hypertension using lercanidipine for stage 1 and lercanidipine/enalapril for stage 2.
This was an open-label, prospective interventional study conducted in 22 general practices in South Africa. Treatment-naïve patients with stage 1 hypertension received lercanidipine 10 mg and patients with stage 2 received lercanidipine 10 mg/enalapril 10 mg. After 6 weeks, patients not reaching target (<140/90 mmHg) were up-titrated to lercanidipine 10 mg/enalapril 10 mg or lercanidipine 10 mg/enalapril 20 mg, respectively, for a further 6 weeks. Office BP was determined at each visit, and 24-hour ambulatory BP monitor (ABPM) at baseline and 12 weeks. The primary end point was changes in office BP, and secondary end points were changes in 24-hour ABPM and BPV.
Of the 198 patients, 48% had stage 1 and 52% stage 2 hypertension. The mean age was 55 years, body mass index was 29.2 kg/m, 48.5% were female, and 15.1% were diabetic. The mean (SD) office SBP and DBP at baseline, 6 weeks, and 12 weeks was 158.2 (13.8), 141.6 (11.1), and 138.7 (16.7) mmHg (<0.00001), and 92.2 (10.6), 84.6 (11.1), and 82 (13.3) mmHg (<0.00001), respectively. The mean (SD) systolic and diastolic daytime ABPM at baseline and 12 weeks was 157 (16.63) and 142 (14.41) mmHg (<0.0001) and 88 (12.34) and 81 (10.79) mmHg (<0.0001), and the nighttime ABPM was 146 (15.68) and 133 (13.94) mmHg (<0.0001) and 79.5 (11.64) and 72.5 (10.05) mmHg (<0.009), respectively. There were few adverse events.
Lercanidipine and lercanidipine/enalapril for stage 1 or 2 hypertension highly improves office SBP and DBP, overall 24-hour BP, daytime BP, and nighttime BP, also reducing BPV with few adverse effects.
描述分层治疗方法对初治收缩期高血压患者的诊室血压（BP）、24小时动态血压及血压变异性（BPV）的疗效，其中1期患者使用乐卡地平，2期患者使用乐卡地平/依那普利。
这是一项在南非22家全科诊所进行的开放标签、前瞻性干预研究。初治1期高血压患者服用10毫克乐卡地平，2期患者服用10毫克乐卡地平/10毫克依那普利。6周后，未达目标血压（<140/90 mmHg）的患者分别加量至10毫克乐卡地平/10毫克依那普利或10毫克乐卡地平/20毫克依那普利，再治疗6周。每次就诊时测定诊室血压，在基线和12周时进行24小时动态血压监测（ABPM）。主要终点为诊室血压变化，次要终点为24小时ABPM及BPV变化。
198例患者中，48%为1期高血压，52%为2期高血压。平均年龄55岁，体重指数为29.2 kg/m，48.5%为女性，15.1%为糖尿病患者。基线、6周和12周时的平均（标准差）诊室收缩压和舒张压分别为158.2（13.8）、141.6（11.1）和138.7（16.7）mmHg（<0.00001），以及92.2（10.6）、84.6（11.1）和82（13.3）mmHg（<0.00001）。基线和12周时的平均（标准差）白天收缩压和舒张压ABPM分别为157（16.63）和142（14.41）mmHg（<0.0001）以及88（12.34）和81（10.79）mmHg（<0.
