| ObjectiveTo observe the effects of amlodipine besylate combined with bisoprolol and the combination of valsartan or hydrochlorothiazide on diastolic blood pressure and the incidence of major cardiovascular and cerebrovascular adverse events in Senile isolated systolic hypertension.Methods180 cases of Senile isolated Systolic Hypertension(SISH)patients who visited the affiliated central hospital of shenyang medical college from October 2017 to March 2018(i.e SBP?160mmHg and DBP<90mmHg)were collected and randomly divided into three groups according to SPSS software,60 cases in each group:Control group(amlodipine+peso),experiment group one(amlodipine+peso+hydrochlorothiazide),experimental group two(amlodipine+peso+valsartan),each group patients were treated for 24 weeks,respectively before and after treatment of 4 weeks,8 weeks,24 hours ambulatory blood pressure,heart rate monitoring and tests of renal function,potassium,blood sugar blood lipids.The all day average diastolic blood pressure(ADADBP),all day average systolic blood pressure(ADASBP),Average heart rate(AHR),and the incidence of major cardiovascular and cerebrovascular events within 24 weeks were recorded.Results1.The control group was included in 60 cases.After 24 weeks of follow-up,2 cases were lost to follow-up,8 cases dropped out of the study,and 50 cases were finally observed.In the first group,60 patients were enrolled.After 24 weeks of follow-up,1 patient was lost to follow-up,5 patients dropped out of the study,and 54 patients were finally observed.60 patients were enrolled in the two groups.After 24 weeks of follow-up,2 patients were lost to follow-up and 3 patients dropped out of the study.Finally,55 cases were observed.2.Comparison of baseline characteristics of patients in each group.There was no significant difference in gender,age,body mass index,duration of hypertension,ADASBP,ADADBP and heart rate,smoking,type 2 diabetes,hyperlipidemia and other indicators between the three groups before treatment(P>0.05).3.Changes of ADADBP,ADASBP,AHR and the incidence of major cardiovascular and cerebrovascular adverse events before and after treatment in 3 groups of patients.(1)Comparison of 24 hours mean diastolic blood pressure(ADADBP)before and after treatment.Before treatment,4 weeks of treatment,8 weeks of treatment,and 24 weeks of treatment were:control group(76.03±3.68mmHg,70.27±2.14mmHg,66.85±2.80 mmHg,66.76±3.16mmHg);experimental group(75.58±3.63mmHg,68.36±2.75 mmHg,65.35±3.01mmHg,65.04±2.88mmHg);experimental two groups(74.72±4.06mmHg,66.28±3.06mmHg,62.86±2.93mmHg,62.77±3.74mmHg).Compared with before treatment,ADADBP was significantly decreased at 4 weeks of treatment(P<0.05),and further decreased after 8 weeks of treatment(P<0.05).After 8 weeks of treatment,there was a further decrease compared with 4 weeks after treatment.There was no significant change in the treatment for 24 weeks,and the ADADBP level was stable(P>0.05).The experimental group and the experimental group were compared with the control group,and the decrease of ADADBP at 4 weeks,8 weeks,and 24 weeks was the largest in the experimental group,the second in the experimental group,and the lowest in the control group(P<0.05).(2)Comparison of 24 hours mean systolic blood pressure(ADASBP)before and after treatment.Before treatment,4 weeks of treatment,8 weeks of treatment,and 24 weeks of treatment were:control group(170.50±4.98mmHg,156.70±8.33mmHg,149.1 8±4.45mmHg,148.98±5.02mmHg);experimental group(171.03±4.14 mmHg,154.03±5.08 mmHg,146.26±5.06mmHg,144.17±4.86mmHg);experimental two groups(169.88±5.49mmHg,145.60±5.22mmHg,136.42±5.51 mmHg,136.06±4.33mmHg).Compared with before treatment,ADASBP was significantly decreased at 4 weeks of treatment(P<0.05),and further decreased after 8 weeks of treatment(P<0.05).After 8 weeks of treatment,there was a further decrease compared with 4 weeks after treatment.There was no significant change in 24 weeks,and the level of ADASBP tended to be stable(P>0.05).The experimental group and the experimental group were compared with the control group,and the decrease of ADASBP was observed at 4 weeks,8 weeks,and 24 weeks:the experimental group was the largest,the experimental group was the second,and the control group was the smallest.The experimental group 2 was lower than the control group.There was a statistically significant difference between the two groups(P<0.05).There was no significant difference between the experimental group and the control group(P>0.05).There was a statistically significant difference between the experimental group and the experimental group(P<0.05).(3)Comparison of the effective rate of blood pressure reduction.The effective rate of blood pressure in the experimental group was significantly higher than that in the control group(92.6%vs.62.0%),and the difference was statistically significant(P<0.05).The effective rate of blood pressure in the experimental group was significantly higher than that in the control group(96.4%vs 62.0%),the two were statistically different(P<0.05);the experimental group and the experimental group were compared with the experimental group(96.4%vs.92.6%),there was no significant difference between the two(P>0.05).(4)Comparison of 24 hours average heart rate(AHR).Compared with before treatment,the AHR decreased slightly in the control group for 4 weeks,and the decrease was not statistically significant(P>0.05).Compared with the treatment for 4 weeks,the AHR decreased significantly after 8 weeks of treatment,and the difference was statistically significant(P<0.05);There was no significant change in AHR level at 24 weeks after treatment compared with 8 weeks of treatment,and there was no significant difference in the decrease(P>0.05).The trend of AHR in the experimental group and the experimental group was consistent with the control group,and there was no significant difference between the two groups(P>0.05).(5)The incidence of major cardiovascular and cerebrovascular adverse eventsWithin 24 weeks of antihypertensive treatment in the 3 groups,the total incidence of cardiovascular and cerebrovascular adverse events in the control group was 12.0%;The total incidence of cardiovascular and cerebrovascular adverse events in the experimental group was 7.4%;the total incidence of cardiovascular and cerebrovascular adverse events in the experimental group was 5.5%;there was no significant difference in the incidence of maj or cardiovascular and cerebrovascular adverse events in the three groups(P>0.05).Conclusions1.Amlodipine combined with bisoprolol can reduce the diastolic blood pressure in elderly patients with isolated systolic hypertension.The combination of hydrochlorothiazide or bisoprolol can further reduce DBP,but the reduction of DBP in the three groups Not large,DBP can be guaranteed above 60mmHg after antihypertensive treatment,suggesting that the three treatment options do not overly reduce DBP.2.The three treatment regimens reduce the amplitude of DBP significantly less than the extent of SBP reduction,and are suitable for the treatment of elderly patients with isolated systolic hypertension(high systolic blood pressure,normal or low diastolic blood pressure),which can reduce the systolic blood pressure without excessively reducing.3.Amlodipine in combination with bisoprolol and valsartan reduced the SBP by more than amlodipine in combination with bisoprolol and hydrochlorothiazide,stronger than amlodipine in combination with bisoprolol,suggesting amlodipine in combination with bisoprol The valsartan and valsartan regimens have better efficacy in reducing SBP in elderly patients with isolated systolic hypertension.4.There was no significant difference in the incidence of major cardiovascular events between the 3 groups of patients within 24 weeks of treatment. |
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