早晨吃降压药或不合适？136项研究汇总分析

2020-08-11 朱朱文韬中国循环杂志

zehuiwang

医生/ 护师

降压药该什么时候吃，高血压指南并没有明确建议。

降压药该什么时候吃，高血压指南并没有明确建议。

近期，西班牙学者分析了136项研究，发现有81.6%的研究显示睡前服用降压药更好。

与晨起或清醒时服药相比，睡前吃药可更好地降低睡眠中的血压，增加夜间血压的相对降幅，即形成杓型血压。

研究者强调，没有任何一项研究显示，传统的晨起降压治疗策略比睡前降压治疗策略带来更多的好处。

此前该研究团队撰文指出，入睡后血压高才是真正的高血压，夜间高血压已成为一个重要的心血管危险标志，入睡后收缩压和非杓形血压与心血管事件风险增加的关系最密切。

在这项新分析中，研究者发现，在103项涉及单个降压药（包括ACEI、ARB、钙拮抗剂、α受体阻滞剂、β受体阻滞剂、袢利尿剂）治疗的研究中，82项（79.6%）研究显示，与晨起/清醒时服药相比，夜间/睡前服药可显著降低血压，主要是对入睡后血压有明显的降低作用，同时适度改善甚至逆转非杓型血压。

在13项报告固定剂量两药治疗的临床研究中，11项（84.6%）发现，夜间/睡前服药的降压效果明显优于晨起/清醒时服药的效果。

另外20项研究评估了多个降压药物服药时间的降压效果，其中18项（90%）研究显示了夜间/睡前服药在改善非杓型血压方面有显著获益。

研究者指出，其余极小部分（18.4%）研究显示“中性”结果，即服药时间对降压效果无明显影响，可能主要与研究设计和实施上存在缺陷有关。

研究者对降压治疗的长期结局研究进一步分析后发现，与晨起/清醒时服药相比，夜间/睡前服用降压药可显著降低主要不良心血管事件发生风险。

Syst-Eur研究显示，与安慰剂相比，夜间服用尼群地平可将2年中风、心血管死亡、总心血管事件发生风险分别降低42%、27%、31%。

Syst-China研究对2394名老年高血压患者随访3年后发现，夜间服用尼群地平可将中风、总死亡、心血管死亡、总心血管事件风险分别降低38%、39%、39%、37%。

HOPE研究中，合并糖尿病的高血压患者夜间服用雷米普利也得到了类似的获益。

但这些研究都是与安慰剂相比，并没有设立同一降压药物的清醒时服药组。

为了弥补这一缺陷，一项大规模Meta分析纳入了170项报告清晨服药的研究，结果显示，与清晨服药相比，夜间/睡前服药将心血管事件发生风险降低了48%。

在此基础上，有学者加入MAPEC研究和Hygia时间治疗试验进一步进行Meta分析，证实夜间/睡前服药有明显的心血管保护作用。

MAPEC是首个比较睡前和晨起服用降压药对心血管风险降低作用的前瞻性、随机、心血管终点临床试验。

中位随访5.6年后发现，睡前服用降压药不仅可显著降低入睡后血压，减少非杓型血压的发生，还能明显降低主要不良心血管事件的发生风险，包括心血管死亡、心肌梗死、中风。

Hygia时间治疗试验是一项规模更大的研究，纳入19084例经动态血压监测诊断的高血压患者。

中位随访6.3年的结果显示，睡前服药组的入睡后平均收缩压或舒张压明显低于清醒时服药组，能更好地维持正常杓型血压曲线，且主要不良心血管事件（死亡、心肌梗死、冠脉血运重建、心衰、中风）风险降低45%。

两组的不良反应和入睡后低血压发生率相似，说明睡前服用降压药物的安全性良好。

研究还显示，不仅一般高血压患者能从睡前服用降压药物中获益，心血管风险较高的患者，例如合并2型糖尿病、慢性肾脏病的患者以及顽固性高血压患者，均有显著获益。

而且，夜间服用降压药可降低新发糖尿病、慢性肾脏病的风险。

不过，研究者表示，这些研究结果还需要进一步进行验证。

来源：

[1]Hermida RC, et al. Does Timing of Antihypertensive Medication Dosing Matter?. Curr Cardiol Rep, 2020, 22(10): 118.

[2]Hermida RC, et al. New perspectives on the definition, diagnosis, and treatment of true arterial hypertension. Expert Opin Pharmacother. 2020, Jun 16:1-12.

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2021-07-07 spoonycyy

#汇总分析#

139 0
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2020-08-11 liangying

请问这跟血压波动的波峰波谷有关联吗

139 1

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2020-08-11 ms4000001210580956

如果真的能有效预防和降低并发症和心血管事件，确实值得推广，期待成果

155 1

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[GetPortalCommentsPageByObjectIdResponse(id=2053577, encodeId=ef0020535e7ef, content=<a href='/topic/show?id=5e5b6429291' target=_blank style='color:#2F92EE;'>#汇总分析#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64292, encryptionId=5e5b6429291, topicName=汇总分析)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3516494, createdName=spoonycyy, createdTime=Wed Jul 07 19:38:43 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=807493, encodeId=150c80e493fa, content=请问这跟血压波动的波峰波谷有关联吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211106/ea1e44326e0946358e849b176cb8f385/463bdae7ebb241129b21a5680b639742.jpg, createdBy=329c5121051, createdName=liangying, createdTime=Tue Aug 11 17:00:59 CST 2020, time=2020-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=807544, encodeId=37bb80e54406, content=如果真的能有效预防和降低并发症和心血管事件，确实值得推广，期待成果, beContent=null, objectType=article, channel=null, level=null, likeNumber=155, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200811/1c64cd7582e447248602e3abc97adaa0/69308d20621c4f2ea919cb71cfa9d419.jpg, createdBy=84d55409423, createdName=ms4000001210580956, createdTime=Tue Aug 11 20:59:17 CST 2020, time=2020-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=884976, encodeId=c2098849e6a2, content=夜间服用<a href='/topic/show?id=3231981537e' target=_blank style='color:#2F92EE;'>#降压药#</a>可降低新发<a href='/topic/show?id=4f77e665253' target=_blank style='color:#2F92EE;'>#糖尿病#</a>、慢性肾脏病的风险，实际上夜间使用降压药，有助于控制晨起高血压，这种最终的获益，可能源自于晨起高血压的控制, beContent=null, objectType=article, channel=null, level=null, likeNumber=309, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98153, encryptionId=3231981537e, topicName=降压药), TopicDto(id=76652, encryptionId=4f77e665253, topicName=糖尿病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Sep 13 17:57:32 CST 2020, time=2020-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=884060, encodeId=72d58840608f, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76d12257050, createdName=12177770m58暂无昵称, createdTime=Wed Sep 09 23:51:21 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1292081, encodeId=aafd129208131, content=<a href='/topic/show?id=9d32981418b' target=_blank style='color:#2F92EE;'>#降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98141, encryptionId=9d32981418b, topicName=降压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Thu Aug 13 07:38:43 CST 2020, time=2020-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=807543, encodeId=334880e5438a, content=如果真的能有效预防和降低并发症和心血管事件，确实值得推广，期待成果, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200811/1c64cd7582e447248602e3abc97adaa0/69308d20621c4f2ea919cb71cfa9d419.jpg, createdBy=84d55409423, createdName=ms4000001210580956, createdTime=Tue Aug 11 20:58:48 CST 2020, time=2020-08-11, status=1, ipAttribution=)]
2020-09-13 lovetcm

夜间服用#降压药#可降低新发#糖尿病#、慢性肾脏病的风险，实际上夜间使用降压药，有助于控制晨起高血压，这种最终的获益，可能源自于晨起高血压的控制

309 0
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2020-09-09 12177770m58暂无昵称

学习了

131 0
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2020-08-13 经常头晕

#降压#

99 0
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2020-08-11 ms4000001210580956

如果真的能有效预防和降低并发症和心血管事件，确实值得推广，期待成果

129 0

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