| ObjectiveCompare the antihypertensive effects of amlodipine combined with carvedilol and bisoprolol on patients with moderate to severe hypertension with elevated diastolic blood pressure(DBP).MethodA collection of 120 patients with moderate to severe diastolic blood pressure(DBP≥100mm Hg)admitted to the outpatient,emergency department and ward of Shenyang Medical College Affiliated Central Hospital from October 2019 to June 2020,and randomly divided into moderate diastolic blood pressure.High subgroup(110mm Hg>DBP≥100mm Hg),severe diastolic blood pressure elevation subgroup(DBP≥110mm Hg),each subgroup was divided into control group and test group.Observe the control group(amlodipine + bisoprolol)and test group(amlodipine + carvedilol)of each subgroup before treatment,14 days after treatment,1 month,3 months,6 months Changes in the patient’s 24-hour average systolic blood pressure(ADASBP),24-hour average diastolic blood pressure(ADADBP),and 24-hour average heart rate(ADAHR),And the incidence of adverse cardiovascular and cerebrovascular events.Result1.Follow-upSubgroup with moderately elevated diastolic blood pressure: 30 cases were selected as the control group.After 6 months of follow-up,3 cases were withdrawn from the subject,1 case was lost to follow-up,and 26 cases were finally completed for observation.Thirty cases were enrolled in the experimental group.After 6 months of follow-up,2 cases withdrew from the subject,3 cases were lost to follow-up,and 25 cases were finally completed observation.Subgroup with severely elevated diastolic blood pressure: 30 cases were enrolled in the control group.After 6 months of follow-up,2 cases withdrew from the subject,2 cases were lost to follow-up,and 26 cases were finally completed observation.In the experimental group,30 cases were enrolled.After 6 months of follow-up,3 cases were withdrawn from the subject,3 cases were lost to follow-up,and 24 cases were finally completed for observation.2.Comparison of baseline characteristics of patients in the control and test groups in the same subgroup before treatmentThrough statistical analysis,it is found that the gender,age,body mass index,duration of hypertension,ADASBP,ADADBP,ADAHR,whether they have type 2 diabetes,whether there is hyperlipidemia,whether they smoke,etc.There was no statistically significant difference in indicators(P>0.05).3.Changes in the 24-hour average systolic blood pressure,24-hour average diastolic blood pressure,24-hour average heart rate and incidence of cardio-cerebrovascular adverse events in the control group and the experimental group of the same subgroup of patients before treatment and 6 months after treatment(1)Changes in ADASBP,ADADBP,ADAHR and the incidence of cardio-cerebrovascular adverse events in the control group and the experimental group of the moderately elevated diastolic blood pressure subgroups before and after treatment○1 Changes in ADASBP before and after treatmentControl group:(before treatment: 139.96±7.26 mm Hg;treatment for 6 months: 127.85±7.74 mm Hg).The ADASBP of 6 months of treatment was significantly lower than that before treatment,and the difference was statistically significant(P<0.01).Test group:(before treatment: 139.88±7.52 mm Hg;treatment for 6 months: 122.20±5.57 mm Hg).The ADASBP of 6 months of treatment was significantly lower than that before treatment,and the difference was statistically significant(P<0.01).The ADASBP of the experimental group was significantly lower than that of the control group,the difference was statistically significant(P<0.05).○2 Changes in ADADBP before and after treatmentControl group:(before treatment: 93.27±4.41 mm Hg;treatment for 6 months: 78.13±4.30 mm Hg).ADADBP after 6 months of treatment was significantly lower than before treatment,and the difference was statistically significant(P<0.01).Test group:(before treatment: 93.36±4.85 mm Hg;treatment for 6 months: 74.13±4.26 mm Hg).ADADBP after 6 months of treatment was significantly lower than before treatment,and the difference was statistically significant(P<0.01).Compared with the control group,the test group had a significant decrease in ADADBP,and the difference was statistically significant(P<0.05).○3 Changes in ADAHR before and after treatmentControl group:(before treatment: 79.23±6.62 times/min;treatment for 6 months: 62.54±2.82 times/min).The ADAHR after 6 months of treatment was significantly lower than that before treatment,and the difference was statistically significant(P<0.01).Test group:(before treatment: 78.96±7.92 times/min;treatment for 6 months: 63.28±5.05 times/min).The ADAHR after 6 months of treatment was significantly lower than that before treatment,and the difference was statistically significant(P<0.01).The decrease in ADAHR between the control group and the experimental group before treatment to 6 months of treatment was similar,and there was no statistical difference(P>0.05).○4 The incidence of cardio-cerebrovascular adverse events before and after treatment.The total incidence of cardio-cerebrovascular adverse events in the control group and the experimental group for 6 months of antihypertensive treatment were: the control group: 7.7% and the experimental group 4%.There was no statistical difference(P>0.05).(2)Changes in ADASBP,ADADBP,ADAHR and the incidence of cardio-cerebrovascular adverse events in the control group and the experimental group of the subgroup of severely elevated diastolic blood pressure before and after treatment① Changes in ADASBP before and after treatmentControl group:(before treatment: 142.88±7.53 mm Hg;treatment for 6 months: 129.08±6.03 mm Hg).The ADASBP of 6 months of treatment was significantly lower than that before treatment,and the difference was statistically significant(P<0.01).Test group:(before treatment: 142.25±8.22mmHg;treatment for 6 months: 124.29±6.03 mm Hg).The ADASBP of 6 months of treatment was significantly lower than that before treatment,and the difference was statistically significant(P<0.01).The ADASBP of the experimental group was significantly lower than that of the control group,the difference was statistically significant(P<0.05).② Changes in ADADBP before and after treatmentControl group:(before treatment: 105.42±4.04 mm Hg;treatment for 6 months: 79.88±3.91 mm Hg).ADADBP after 6 months of treatment was significantly lower than before treatment,and the difference was statistically significant(P<0.01).Test group:(before treatment: 105.21±4.04 mm Hg;treatment for 6 months: 75.38±4.19 mm Hg).ADADBP after 6 months of treatment was significantly lower than before treatment,and the difference was statistically significant(P<0.01).Compared with the control group,the test group had a significant decrease in ADADBP,and the difference was statistically significant(P<0.05).③ Changes in ADAHR before and after treatmentControl group:(before treatment: 80.15±5.66 times/min;treatment for 6 months: 63.46±3.66 times/min).The ADAHR after 6 months of treatment was significantly lower than that before treatment,and the difference was statistically significant(P<0.01).Test group:(before treatment: 80.21±6.39 times/min;treatment for 6 months: 64.37±3.66 times/min).The ADAHR after 6 months of treatment was significantly lower than that before treatment,and the difference was statistically significant(P<0.01).The decrease in ADAHR between the control group and the experimental group before treatment to 6 months of treatment was similar,and there was no statistical difference(P>0.05).④ The incidence of cardio-cerebrovascular adverse events before and after treatment.The total incidence of cardio-cerebrovascular adverse events in the control group and the experimental group for 6 months of antihypertensive treatment were: control group: 15.4%,experimental group 8.3%,There was no statistical difference(P>0.05).Conclusions1.Amlodipine combined with carvedilol and bisoprolol are effective in reducing systolic blood pressure in hypertensive patients with moderate to severe elevated diastolic blood pressure.Amlodipine combined with carvedilol has a better effect on reducing systolic blood pressure.2.Amlodipine combined with carvedilol and bisoprolol are effective in reducing diastolic blood pressure in hypertensive patients with moderate to severe diastolic blood pressure.Amlodipine combined with carvedilol has a better effect on reducing diastolic blood pressure.3.Amlodipine combined with carvedilol and bisoprolol are effective in reducing heart rate in patients with moderate to severe diastolic blood pressure and hypertension,but there is no statistical difference in the effect of the two in reducing heart rate.4.There was no statistical difference in the incidence of cardiovascular and cerebrovascular adverse events during the 6 months of treatment of amlodipine combined with carvedilol and bisoprolol on hypertensive patients with moderate to severe diastolic blood pressure. |
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