钙通道阻滞剂在不同血脂异常高血压患者中的疗效差异：马来酸左旋氨氯地平与苯磺酸氨氯地平在高血压治疗中的比较效果研究亚组分析

The efficacy of calcium channel blocker in hypertensives with different dyslipidemia: LEADER subgroup analysis

    摘要
  • 摘要: 目的 探讨钙通道阻滞剂(CCB)对不同血脂异常高血压患者血压的影响。方法 本文数据来源于马来酸左旋氨氯地平与苯磺酸氨氯地平在高血压治疗中的比较效果研究(LEADER)中基线血脂资料完整的2 341例高血压患者。按照研究方案，患者服用CCB苯磺酸氨氯地平或马来酸左旋氨氯地平治疗并随访24个月，共进行7次随访。根据基线血清总胆固醇和三酰甘油水平将入选患者分为四组：混合高脂组(总胆固醇≥6.2且三酰甘油≥2.3 mmol/L),高胆固醇组(总胆固醇≥6.2 mmol/L且三酰甘油<2.3 mmol/L),高三酰甘油组(总胆固醇<6.2 mmol/L且三酰甘油≥2.3 mmol/L),血脂正常组(总胆固醇<6.2 mmol/L且三酰甘油<2.3 mmol/L),比较各组患者服用CCB后的血压达标率、血压降低幅度的差异。结果 不同血脂异常分组患者的收缩压降幅差异有统计学意义(F=3.451,P=0.016);不同时间患者的收缩压降幅(F=89.298,P<0.001)、舒张压降幅(F=41.774,P<0.001)差异有统计学意义。与血脂正常组比较，高三酰甘油组和混合高脂组的血压达标率降低(P<0.001);不同时间患者的血压达标率与基线血压达标率差异有统计学意义(均P<0.05)。调整混杂因素后，与血脂正常组相比，混合高脂组接受CCB治疗1个月(β=2.740,95%CI 1.130～4.350)、2个月(2.185,0.622～3.747)、3个月(2.949,1.478～4.419)、6个月(2.556,1.159～3.953)、12个月(2.141,0.793～3.488)和18个月(1.776,0.490～3.062)收缩压降幅增加；调整混杂因素后，混合高脂组接受CCB治疗1个月(OR=0.507,95%CI 0.363～0.709)、2个月(0.557,0.390～0.796)、3个月(0.661,0.450～0.972)、6个月(0.648,0.425～0.988)、12个月(0.577,0.370～0.900)血压达标率低于血脂正常组，治疗18个月及24个月两组达标率差异无统计学意义。结论 合并高脂血症的高血压患者血压水平更高、达标率更低；不同血脂水平的高血压患者对CCB的降压反应(收缩压)存在差异，CCB对合并混合型高脂血症患者的降压疗效更好。

     

    Abstract: Objective To explore the effects of calcium channel blocker（CCB） on blood pressure and short-term prognosis of hypertension patients with different types of dyslipidemias. Methods The data was from 2 341 hypertensive patients with complete baseline blood lipid data in levoamlodipine maleate or amlodipine beaylate for treatment of hypertension: a comparative effectiveness research（LEADER）. Under the study protocol, patients were followed up for 24 months（including 7 visits） after treated with amlodipine or levoamlodipine. According to the baseline serum total cholesterol（TC） and triglyceride（TG） levels, patients were divided into four groups: mixed high lipid group（TC≥6.2 mmol/L and TG≥2.3 mmol/L）, high cholesterol group（TC≥6.2 mmol/L and TG＜2.3 mmol/L）, high triglyceride group（TC＜6.2 mmol/L and TG≥2.3 mmol/L）, and normal lipid group（TC＜6.2 mmol/L and TG＜2.3 mmol/L）. The blood pressure compliance rate and blood pressure reduction in each group after the treatment were compared. Results The systolic blood pressure（SBP） reduction was significantly different between each group（F=3.451, P=0.016）. The decrease of SBP（F=89.298, P＜0.001） and diastolic blood pressure（F=41.774, P＜0.001） were significantly different between each visits. The blood pressure compliance rate was significantly different between each group. Compared to the normal blood pressure group, the blood pressure compliance rate of high triglyceride group and mixed high lipid group was significantly lower（P＜0.001）. Compared with the baseline, the improvement of blood pressure compliance rate at each visit was statistically significant（P＜0.05）. After adjusting for confounding factors, compared with the normal lipid group, the reduction of SBP in the mixed high lipid group at 1st（β=2.740, 95%CI 1.130-4.350）, 2nd（β=2.185, 95%CI 0.622-3.747）, 3rd（β=2.949, 95%CI 1.478-4.419）, 6th（β=2.556, 95%CI 1.159-3.953）, 12th（β=2.141, 95%CI 0.793-3.488） and 18th month（β=1.776, 95%CI 0.490-3.062） after the treatment was significantly increased. After adjusting for confounding factors, blood pressure compliance rate of mixed high lipid group was lower than normal lipid group at the 1st（OR=0.507, 95%CI 0.363-0.709）, 2nd（OR=0.557, 95%CI 0.390-0.796）, 3rd（OR=0.661, 95%CI 0.450-0.972）, 6th（OR=0.648, 95%CI 0.425-0.988）, and 12th month（OR=0.577, 95%CI 0.370-0.900） of CCB treatment, but didn’t show difference at the 18th and 24th month. Conclusions Hypertensive patients with hyperlipidemia had higher blood pressure and lower compliance rate. Hypertensive patients with different blood lipid levels may have different antihypertensive responses（SBP） to CCB, and CCB may have a better antihypertensive effect on patients with mixed hyperlipidemia.

     

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