| Background:Hypertension is a major public health problem worldwide and has become a major risk factor for human death.China has a large population and limited economic development,resulting in scarcity of medical resources.At present,the prevention and treatment of chronic diseases such as hypertension has been gradually transferred to community clinics.Studies have shown that self-management of hypertension patients in community is still at a relatively low level.Many patients still can not correctly treat hypertension,including the rational choice of antihypertensive drugs,the correct grasp of medication time,timely feedback of medication efficacy,early detection of target organ damage and so on,resulting in poor blood pressure control and increased adverse cardiovascular and cerebrovascular events.The purpose of this study is to guide community hypertension patients to better control blood pressure and prevent complications.Objectives:This study selected patients with essential hypertension diagnosed in our hospital from 2017.01 to 2018.01 outpatient clinic.By observing and comparing the basic clinical situation of patients,the curative effect of taking medicine before breakfast,after breakfast,as well as ambulatory blood pressure measurement(ambulatory blood pressure monitoring,analysis and comparison before taking medicine and after taking medicine for 8 weeks)and drug side effects,each group was divided into three groups.Target organ damage in hypertensive patients:ECG,UALB,LVEDd and ABI were analyzed and compared before and 12 months after taking medicine.The efficacy,drug safety and target organ protection of hypertensive patients at different time were compared.Methods:A total of 300 patients with essential hypertension who were treated in our hospital’s hypertensive chronic disease clinic were selected by random number table method.The blood pressure of all patients was in accordance with the guidelines for basic management of hypertension in China(2014 Revision),including new cases and past confirmed cases.Among them,the former confirmed cases were those who stopped taking hypertensive drugs for more than 2 weeks and the original therapeutic effect was not satisfactory.Excellent,patients who need to adjust the treatment regimen should be excluded from secondary hypertension such as hyperaldosteronism(PA),pheochromocytoma,Cushing syndrome(CS),Sleep Apnea Hypopnea Syndrome(SAHS),pregnancy hypertension,white coat hypertension(WCH),and present hypertension.Treatment can effectively control blood pressure and patients who can’t insist on completing clinical research.Routine blood routine examination,urinary microalbumin(UALB),blood biochemistry(liver function,kidney function,blood sugar,blood lipid,blood electrolyte,C-reactive protein),electrocardiogram,cardiac ultrasound,ankle/arm index(ABI),24-hour ambulatory blood pressure were performed before enrollment.All patients were treated with olmesartan ester tablets 20 mg a day,and patients with moderate or severe hypertension were treated with levo benzenesulfonate.Amlodipine tablets were taken orally once a day for 5 mg.All patients agreed,cooperated with the examination and treatment,signed the informed consent and followed up in the clinic,and participated in family follow-up.According to the requirements of prospective experiment,300 eligible patients were divided into non-ambulatory blood pressure group(180 cases)and ambulatory blood pressure group(120 cases)by random number table method.Among them,non-ambulatory blood pressure group was divided into pre-meal medication group and post-meal medication group(90 cases).The pre-meal medication group took it within 60-90 minutes before breakfast,and the post-meal medication group took it within 30-60 minutes after breakfast.According to the peak blood pressure and pharmacokinetics,patients with mild hypertension took olmesartan ester tablets 2 hours ahead of the peak blood pressure daily.Patients with moderate and severe hypertension took Levamlodipine besylate tablets before going to bed at night.After 8 weeks of regular administration,ambulatory blood pressure was measured once in each group,and target organ damage was measured 12 months later.All patients had informed consent to the treatment plan and were willing to cooperate with the follow-up.By observing the therapeutic effect and adverse drug reactions,the average values measured by ABPM,left ventricular voltage(RV5+SV1)calculated by ECQ left ventricular end-diastolic diameter(LVEDd),ankle/arm index(ABI),major acute cardiovascular and cerebrovascular adverse events(including coronary heart disease,myocardial infarction,cerebral hemorrhage,hypertensive encephalopathy),the overall blood pressure control and main drugs were evaluated.Adverse reactions,major acute and chronic target organ injuries,and comprehensive evaluation of curative effect to guide clinical medication.All the data were processed by SPSS 24.0 data analysis software.The counting data were expressed by mean(+SD).The comparison between groups was performed by t-test and the measurement data by 2-test.The difference was statistically significant with P<0.05 and P<0.01.Results:336 patients with primary hypertension were selected in this study,excluding 6 secondary hypertension,9 cases of disconnection,3 case of white coat hypertension and 18 cases of drug replacement in the middle of the study.Finally,300 patients were included in the study,including 204 males,96 females,195 new patients and 105 previously diagnosed patients.1.Comparison of basic clinical features:There were no significant differences in age,sex,basic gastric history,diabetes mellitus,hyperlipidemia,smoking,drinking,body mass index,circadian rhythm of blood pressure and past history between the two groups(P>0.05).There was no significant difference in laboratory data analysis between the two groups(P>0.05).2.Comparison of curative effects:2.1.The blood pressure in non-ambulatory blood pressure group was effectively controlled by both pre-meal and post-meal medication groups.The total effective rates were 93.3%(84/90)and 73.3%(66/90)respectively after 8 weeks of treatment.The effect of pre-meal medication group was significantly better than that of post-meal medication group(P<0.05).The total effective rates were 83,3%(150/190)and 97.5%(117/120)after 8 weeks of administration.There was significant difference between the two groups.The efect of ambulatory blood pressure group was better than that of non-ambulatory blood pressure group(P<0.01).2.2.After 8 weeks of treatment,compared d-SBP,d-DBP and d-MAP;n-SBP,n-DBP and n-MAP;24-h-MSBP,24-h-MDBP and 24-h-MMAP;SBP,DBP%;24-h circadian rhythm of blood pressure fluctuation,24-h total blood pressure load,morning peak blood pressure,etc.before and after treatment,there were significant differences(P<0.01).The circadian rhythm of 24-hour blood pressure fluctuation,24-hour total blood pressure load and morning peak blood pressure in non-ambulatory blood pressure group were different from those in postprandial group(P<0.05),such as d-SBP,d-DBP and d-MAP,n-SBP,n-DBP and n-MAP,24-hour MSBP,24-hour MDBP and 24-hour MMAP,SBP%.Compared with non-ambulatory blood pressure group,ambulatory blood pressure group had significant differences in D d-SBP,d-DBP and d-MAP,n-SBP,n-DBP and n-MAP,24 h-MSBP,24 h-MDBP and 24 h-MMAP,SBP,DBP%,24 h blood pressure fluctuation circadian rhythm,24 h total blood pressure load,morning peak blood pressure(P<0.01),and ambulatory blood pressure group could control morning peak blood pressure more effectively and recover normal dipper day.Type B blood pressure rhythm.3.Comparisons of major target organ injuries:12 months after treatment,the overall comparison of electrocardiogram RV5+SV1(mv),left ventricular end diastolic diameter(LVEDd)(mm),urine microalbumin(UALB)(ng/ml),urine microalbumin(UALB),and ankle/arm index(ABI)[(2.90±0.581):(2.70±0.560);(50.26±3.71):(46.89±3.15);(12.29±3.79):(10.67±3.78);(1.07±0.174):(1.14±0.162)](P<0.01).After treatment,target organ damage indexes of target organ injury were compared between pre-meal group and post-meal group after treatment and target organ damage indexes of ECG RV5+SV1,left ventricular end diastolic diameter(LVEDd),urinurine microalbumin(UALB),and ankle/arm index(ABI))[(2.69 ±0.714):(2.80 ±0.484);(47.9 ±2.87):(47.8±4.02);(10.5±4.37):(11.3 ±4.28);(1.12±0.155):(1.09±0.191)],The above comparisons are different,but have no statistical significance.Meaning(P>0.05).The target organ damage indexes of non-ambulatory blood pressure group and ambulatory blood pressure group after treatment were compared with those of RV5+SV1 and UALB[(2.75±0.598):(2.62±0.490);(11.0±4.33):(10.2±2.74)].There was no significant difference between the two groups(P>0.05).ABI(1.10±0.176):(1.19±0.124),the difference was statistically significant(P<0.01).LEVDd(47.8+3.55):(45.5+1.63),there was a significant difference between the two groups(P<0.01).4.Comparison of adverse drug reactions:Comparisons of adverse reactions after medication between pre-meal group and post-meal group:18 cases of pre-meal group and 4 cases of post-meal group;P value between the two groups was 0.032,with statistical difference(P<0.05).Comparisons between non-ambulatory blood pressure group and ambulatory blood pressure group:22 cases of non-ambulatory blood pressure group and 12 cases of ambulatory blood pressure group;P value was 0.961 between the two groups,but there was no significant difference(P>0.05).Conclusions:1.Each group can effectively reduce blood pressure,and the pre-meal medication group is more effective than the post-meal medication group in the treatment of essential hypertension,systolic and diastolic blood pressure are significantly reduced.2.Ambulatory blood pressure group is more effective than non-ambulatory blood pressure group in the treatment of essential hypertension.Both systolic and diastolic blood pressure decrease significantly,and it can effectively avoid morning peak blood pressure,restore normal dipper blood pressure,and reduce blood pressure smoothly and safely.3.Pre-meal medication group can improve the degree of target organ damage compared with post-meal medication group,but there is no statistical significance;ambulatory blood pressure group can improve the effective prevention of target organ damage compared with non-ambulatory blood pressure group;overall treatment has obvious target organ protection effect than before treatment.4.Postprandial group had fewer adverse drug reactions than pre-prandial group. |
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