目的 探討山菊降壓片聯合福辛普利治療老年原發(fā)性高血壓的臨床效果。方法 選取2019年10月—2021年6月華北醫(yī)療健康集團峰峰總醫(yī)院收治的136例老年原發(fā)性高血壓患者，按隨機數字表法將這136例患者分成對照組和治療組，每組各68例。對照組口服福辛普利鈉片，初始劑量10 mg/次，1次/d，連用4周后調整至40 mg/次，1次/d。治療組在對照組基礎上口服山菊降壓片，5片/次，2次/d。兩組均連續(xù)治療12周。觀察兩組的臨床療效，比較兩組治療前后診室血壓參數[收縮壓（SBP）、舒張壓（DBP）、脈壓差（PP）]、動態(tài)血壓參數（24 h、白天、夜間、清晨4個時段的SBP和DBP值）及血清內皮素-1（ET-1）、一氧化氮（NO）、腫瘤壞死因子（TNF）-α、基質金屬蛋白酶-9（MMP-9）和組織金屬蛋白酶抑制物1（TIMP-1）水平。結果 治療后，治療組總有效率為94.1%，顯著高于對照組的82.4%（P＜0.05）。治療后，兩組診室SBP、DBP、PP值均顯著低于治療前（P＜0.05）；且治療后，治療組診室SBP、DBP、PP值改善均顯著優(yōu)于對照組（P＜0.05）。治療后，兩組24 h、白天、夜間、清晨的SBP和DBP值較治療前均顯著下降（P＜0.05）；且治療后，治療組以上各項動態(tài)血壓相關參數的改善效果較對照組更顯著（P＜0.05）。治療后，兩組血清ET-1、TNF-α、MMP-9和TIMP-1水平均顯著降低，血清NO水平均顯著上升（P＜0.05）；且治療后，治療組血清ET-1、TNF-α、MMP-9和TIMP-1水平低于對照組，NO水平高于對照組（P＜0.05）。結論 山菊降壓片聯合福辛普利治療老年原發(fā)性高血壓可有效且平穩(wěn)地控制患者血壓，并能進一步降低血中ET-1、TNF-α、MMP-9和TIMP-1水平及升高血中NO水平，且患者耐受性好，值得臨床推廣。

Objective To investigate the clinical effect of Shanju Jiangya Tablets combined with fosinopril in treatment of senile essential hypertension. Methods A total of 136 elderly patients with primary hypertension admitted to Fengfeng General Hospital of North China Medical and Health Group from October 2019 to June 2021 were selected and divided into control group and treatment group according to random number table method, with 68 cases in each group. Patients in the control group were po administered with Fosinopril Sodium Tablets, the initial dosage was 10 mg/time, once daily, and was adjusted to 40 mg/time, once daily after 4 weeks. Patients in the treatment group were po administered with Shanju Jiangya Tablets on the basis of the control group, 5 tablets/time, twice daily. Both groups were treated continuously for 12 weeks. The clinical efficacy of the two groups was observed, and the office blood pressure parameters [systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure difference (PP)], ambulatory blood pressure parameters (SBP and DBP values in 4 periods of 24 h, daytime, nighttime, and morning), serum endothelin-1 (ET-1), nitric oxide (NO), tumor necrosis factor (TNF)-α, matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of metalloproteinase 1 (TIMP-1) levels were compared between the two groups before and after treatment. Results After treatment, the total effective rate of the treatment group was 94.1%, which was significantly higher than that of the control group (82.4%, P< 0.05). After treatment, the values of SBP, DBP and PP in two groups were significantly lower than before treatment (P < 0.05). After treatment, the improvement of SBP, DBP and PP in the treatment group was significantly better than that in the control group (P< 0.05). After treatment, SBP and DBP values of 24 h, day, night and morning in two groups were significantly decreased compared with before treatment (P< 0.05). After treatment, the improvement effect of the above ambulatory blood pressure related parameters in the treatment group was more significant than that in the control group (P < 0.05). After treatment, the serum levels of ET-1, TNF-α, MMP-9 and TIMP-1 in two groups were significantly decreased, while the serum NO level was significantly increased (P < 0.05). After treatment, the levels of ET-1, TNF-α, MMP-9 and TIMP-1 in the treatment group were lower than those in the control group, while the levels of NO in the treatment group were higher than those in the control group (P < 0.05). Conclusion Shanju Jiangya Tablets combined with fosinopril can effectively and stably control blood pressure in treatment of senile essential hypertension, further reduce the levels of ET-1, TNF-α, MMP-9 and TIMP-1 in blood and increase the level of NO in blood, which is well tolerated by patients and worthy of clinical promotion.

R972

邯鄲市科學技術研究與發(fā)展計劃項目（1623208102ZC）