Hypertension:慢性肾病患者降压晨起方案更好

　　美国学者的一项研究表明，在伴有高血压性慢性肾病的黑人患者中，夜间和追加给药方案在降低夜间血压方面不优于晨起方案。论文于2012年11月19日在线发表于《高血压》（Hypertension）杂志。

　　此项3周期交叉试验共纳入147例平均年龄为65.4岁的受试者，其中男性为64%，平均eGFR为44.9 ml/（min·1.73 m²）。受试者随机接受各持续6周的3种方案治疗；分别为AM方案（晨起每日一次应用降压药）、PM方案（睡前每日一次应用降压药）和追加方案（晨起应用一次降压药并于睡前添加一种降压药）。在各方案周期终结时监测动态血压。主要转归为夜间收缩压。

　　结果显示，AM方案、PM方案和追加方案应用终结时收缩压分别为125.6、123.9和123.5 mmHg。夜间、24小时和日间收缩压配对差异均不具有统计学意义。在伴有高血压性慢性肾病的黑人受试者中，与AM用药方案相比，PM方案和最佳方案均未能显著降低夜间血压。

A Trial of 2 Strategies to Reduce Nocturnal Blood Pressure in Blacks With Chronic Kidney Disease

Abstract

The objective of our study was to determine the effects of 2 antihypertensive drug dose schedules (PM dose and add-on dose) on nocturnal blood pressure (BP) in comparison with usual therapy (AM dose) in blacks with hypertensive chronic kidney disease and controlled office BP. In a 3-period, crossover trial, former participants of the African American Study of Kidney Disease were assigned to receive the following 3 regimens, each lasting 6 weeks, presented in random order: AM dose (once-daily antihypertensive medications taken in the morning), PM dose (once-daily antihypertensives taken at bedtime), and add-on dose (once-daily antihypertensives taken in the morning and an additional antihypertensive medication before bedtime [diltiazem 60–120 mg, hydralazine 25 mg, or additional ramipril 5 mg]). Ambulatory BP monitoring was performed at the end of each period. The primary outcome was nocturnal systolic BP. Mean age of the study population (n=147) was 65.4 years, 64% were men, and mean estimated glomerular filtration rate was 44.9 mL/min per 1.73 m2. At the end of each period, mean (SE) nocturnal systolic BP was 125.6 (1.2) mm Hg in the AM dose, 123.9 (1.2) mm Hg in the PM dose, and 123.5 (1.2) mm Hg in the add-on dose. None of the pairwise differences in nocturnal, 24-hour, and daytime systolic BP was statistically significant. Among blacks with hypertensive chronic kidney disease, neither PM (bedtime) dosing of once-daily antihypertensive nor the addition of drugs taken at bedtime significantly reduced nocturnal BP compared with morning dosing of antihypertensive medications.