目的 探討米氮平聯(lián)合氨氯地平治療老年高血壓伴焦慮抑郁的臨床療效。方法 收集2012年10月-2015年10月新鄉(xiāng)醫(yī)學院第二附屬醫(yī)院收治的老年高血壓伴焦慮抑郁患者85例，隨機分為對照組（42例）和治療組（43例）。對照組患者睡前口服苯磺酸氨氯地平片，5 mg/次，1次/d。治療組在對照組的基礎上早晨口服米氮平片，起始量為15 mg，1次/d，1周內根據患者情況酌情加至30 mg。兩組患者均連續(xù)治療12周。觀察兩組患者降壓療效和血壓水平，比較兩組治療前后漢密爾頓抑郁量表（HAMD）評分、漢密爾頓焦慮量表（HAMA）評分和生活質量評價量表（SF-36）評分的變化。結果 治療后，對照組總有效率為69.05%，治療組總有效率為90.70%，兩組總有效率比較差異具有統(tǒng)計學意義（P<0.05）。治療后，兩組患者收縮壓、舒張壓均顯著降低（P<0.05）；與對照組相比，治療后治療組血壓下降更為明顯，兩組比較差異具有統(tǒng)計學意義（P<0.05）。治療4、8、12周后，治療組患者HAMD和HAMA評分顯著降低，同治療前比較差異有統(tǒng)計學意義（P<0.05）；且治療組上述評分低于對照組，兩組比較差異有統(tǒng)計學意義（P<0.05）。治療后，兩組患者SF-36各項評分均得到改善，同組治療前后差異具有統(tǒng)計學意義（P<0.05）；且除社會功能評分外，治療后治療組其余SF-36評分高于對照組，兩組比較差異具有統(tǒng)計學意義（P<0.05）。結論 米氮平聯(lián)合氨氯地平治療老年高血壓伴焦慮抑郁能提高氨氯地平的降壓效果，改善患者的心理狀態(tài)，提高生活質量。

Objective To observe the clinical curative effect of mirtazapine combined with amlodipine in treatment of senile hypertension with anxiety and depression. Methods Patients (85 cases) with elderly hypertension with anxiety and depression in The Second Affiliated Hospital of Xinxiang Medical University from October 2012 to October 2015 were randomly divided into control (42 cases) and treatment (43 cases) groups. The patients in the control group were po administered with Amlodipine Besylate Tablets before sleeping, 5 mg/time, once daily. The patients in the treatment group were po administered with Mirtazapine Tablets in the morning on the basis of the control group, the initial dose was 15 mg and added to 30 mg according to the patient's condition within one week, once daily. The patients in two groups were treated for 12 weeks. After treatment, the antihypertensive efficacy and blood pressure level were evaluated, and the changes of HAMD, HAMA, and SF-36 scores in two groups before and after treatment were compared. Results After treatment, the efficacies in the control and treatment groups were 69.05% and 90.70%, respectively, and there were differences between two groups (P<0.05). After treatment, systolic and diastolic blood pressure in two groups were significantly decreased (P<0.05). Compared with the control group, the blood pressure level in the treatment group was lower than those in the control group, with significant difference between two groups (P<0.05). After treatment for 4, 8, and 12 weeks, HAMD and HAMA scores in the treatment group were significantly decreased, and the difference was statistically significant in the treatment group before and after treatment (P<0.05). And these scores in the treatment group were lower than those in the control group, with significant difference between two groups (P<0.05). After treatment, the SF-36 scores in two groups were significantly improved, and the difference was statistically significant in the same group (P<0.05). And except the social function score, the other SF-36 scores in the treatment group were higher than those in the control group, with significant difference between two groups (P<0.05). Conclusion Mirtazapine combined with amlodipine has good efficacies in treatment of elderly hypertension with anxiety and depression and can improve the antihypertensive efficacy of amlodipine, the psychological status of patients, and quality of life.

河南省衛(wèi)生科技創(chuàng)新型人才工程專項（YWZY201348）