晚上服用血压药物效果更好


  【24drs.com】根据新研究指出,罹患慢性肾脏病(CKD)和高血压的病患,睡前服用至少一种降血压药物,可显著改善血压控制,且与降低心血管事件风险有关。
  
  西班牙Campus Universitario、Vigo大学生物工程暨慢性病生物学实验室的Ramon C. Hermida博士等人在10月24日的美国肾脏医学会期刊(Journal of the American Society of Nephrology)在线发表他们的研究结果。
  
  研究人员表示,晚上服用降血压药物的好处之前曾被提出,但是,降低就寝时间的血压与减少心血管疾病(CVD)风险之间的关联则仍有所争议。目前的这篇前瞻研究试图探讨高血压CKD病患在就寝时间服用降血压药物治疗时,血压控制和降低CVD风险方面是否较优。
  
  这篇研究包括了661名CKD病患,将他们随机分组,一组完全没有睡前服用的药物,一组在就寝时间服用其中至少一种药物;每年至少测试一次48小时血压值,在调整任何治疗之后3个月时也要测一次。
  
  心血管事件的测量指标包括死亡、心肌梗塞、心绞痛、血管重建术、心衰竭、下肢动脉阻塞、视网膜动脉阻塞、中风等,研究的控制变项包括性别、年纪和糖尿病。
  
  病患被追踪的期间中位数为5.4年;在追踪期间内,就寝时服用至少一种降血压药物者的CVD风险几乎是对照组的三分之一(校正风险比[HR]为0.31;95%信心区间[CI]为0.21 - 0.46;P < .001)。
  
  如果只分析心血管因素死亡、心肌梗塞和中风时,就寝时间给药仍显著降低风险(校正HR,0.28;95% CI,0.13 - 0.61;P < .001)。
  
  就寝时间服药药物者在睡觉时的平均血压值也比较低,这些病患的连续血压控制也比较好(56% vs 45%;P = .003)。
  
  研究人员估计,睡觉时间的收缩压平均降低5 mmHg,追踪期间的心血管事件风险降低14% (P < .001)。
  
  根据Hermida博士等人指出,就寝时治疗是最具成本效益且最简单的疗法,可成功达到适当降低睡眠期间血压的治疗目标,且保留或重建正常的24小时血压变动模式。
  
  作者们认为,夜间治疗之好处的可能解释或许与夜间治疗对尿液白蛋白分泌的影响有关。他们以前认为使用valsartan治疗时,尿液白蛋白分泌在睡觉后显著降低,白天则没有这样的情况;此外,这与血压的24小时变化无关,但是和睡觉时的血压降低有关。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6639&x_classno=0&x_chkdelpoint=Y
  

BP Medications More Effective When Given at Night

By Emma Hitt, PhD
Medscape Medical News

October 26, 2011 — Among patients with chronic kidney disease (CKD) and hypertension, taking at least 1 antihypertensive medication at bedtime significantly improves blood pressure (BP) control, with an associated decrease in risk for cardiovascular events, according to new research.

Ramon C. Hermida, PhD, and colleagues from the Bioengineering and Chronobiology Laboratories at the University of Vigo, Campus Universitario, Spain, published their findings online October 24 in the Journal of the American Society of Nephrology.

According to the researchers, the beneficial effect of taking BP medication at night has been previously documented, but "the potential reduction in [cardiovascular disease (CVD)] risk associated with specifically reducing sleep-time BP is still a matter of debate."

The current prospective study sought to investigate in hypertensive patients with CKD whether bedtime treatment with hypertension medications better controls BP and reduces CVD risk compared with treatment on waking.

The study included 661 patients with CKD who were randomly assigned either to take all prescribed hypertension medications on awakening or to take at least 1 of them at bedtime. Ambulatory BP at 48 hours was measured at least once a year and/or at 3 months after any adjustment in treatment.

The composite measure of cardiovascular events used included death, myocardial infarction, angina pectoris, revascularization, heart failure, arterial occlusion of lower extremities, occlusion of the retinal artery, and stroke. The investigators controlled their results for sex, age, and diabetes.

Patients were followed for a median of 5.4 years; during that time, patients who took at least 1 BP-lowering medication at bedtime had approximately one third of the CVD risk compared with those who took all medications on awakening (adjusted hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.21 - 0.46; P < .001).

A similar significant reduction in risk with bedtime dosing was noted when the composite CVD outcome included only cardiovascular death, myocardial infarction, and stroke (adjusted HR, 0.28; 95% CI, 0.13 - 0.61; P < .001).

Patients taking their medications at bedtime also had a significantly lower mean BP while sleeping, and a greater proportion of these patients had ambulatory BP control (56% vs 45%; P = .003).

The researchers estimate that for each 5-mm-Hg decrease in mean sleep-time systolic BP, there was a 14% reduction in the risk for cardiovascular events during follow-up (P < .001).

According to Dr. Hermida and colleagues, "treatment at bedtime is the most cost-effective and simplest strategy of successfully achieving the therapeutic goals of adequate asleep BP reduction and preserving or re-establishing the normal 24-hour BP dipping pattern."

The authors suggest that a potential explanation for the benefit of nighttime treatment may be associated with the effect of nighttime treatment on urinary albumin excretion levels. "We previously demonstrated that urinary albumin excretion was significantly reduced after bedtime, but not morning, treatment with valsartan," they note. In addition, this reduction was independent of 24-hour changes of BP, but correlated with a decline in BP during sleep.

The study was not commercially supported. The authors and editorialists have disclosed no relevant financial relationships.

J Am Soc Nephrol. Published online October 24, 2011.

    
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