晚上服用血壓藥物效果更好


  【24drs.com】根據新研究指出,罹患慢性腎臟病(CKD)和高血壓的病患,睡前服用至少一種降血壓藥物,可顯著改善血壓控制,且與降低心血管事件風險有關。
  
  西班牙Campus Universitario、Vigo大學生物工程暨慢性病生物學實驗室的Ramon C. Hermida博士等人在10月24日的美國腎臟醫學會期刊(Journal of the American Society of Nephrology)線上發表他們的研究結果。
  
  研究人員表示,晚上服用降血壓藥物的好處之前曾被提出,但是,降低就寢時間的血壓與減少心血管疾病(CVD)風險之間的關聯則仍有所爭議。目前的這篇前瞻研究試圖探討高血壓CKD病患在就寢時間服用降血壓藥物治療時,血壓控制和降低CVD風險方面是否較優。
  
  這篇研究包括了661名CKD病患,將他們隨機分組,一組完全沒有睡前服用的藥物,一組在就寢時間服用其中至少一種藥物;每年至少測試一次48小時血壓值,在調整任何治療之後3個月時也要測一次。
  
  心血管事件的測量指標包括死亡、心肌梗塞、心絞痛、血管重建術、心衰竭、下肢動脈阻塞、視網膜動脈阻塞、中風等,研究的控制變項包括性別、年紀和糖尿病。
  
  病患被追蹤的期間中位數為5.4年;在追蹤期間內,就寢時服用至少一種降血壓藥物者的CVD風險幾乎是對照組的三分之一(校正風險比[HR]為0.31;95%信心區間[CI]為0.21 - 0.46;P < .001)。
  
  如果只分析心血管因素死亡、心肌梗塞和中風時,就寢時間給藥仍顯著降低風險(校正HR,0.28;95% CI,0.13 - 0.61;P < .001)。
  
  就寢時間服藥藥物者在睡覺時的平均血壓值也比較低,這些病患的連續血壓控制也比較好(56% vs 45%;P = .003)。
  
  研究人員估計,睡覺時間的收縮壓平均降低5 mmHg,追蹤期間的心血管事件風險降低14% (P < .001)。
  
  根據Hermida博士等人指出,就寢時治療是最具成本效益且最簡單的療法,可成功達到適當降低睡眠期間血壓的治療目標,且保留或重建正常的24小時血壓變動模式。
  
  作者們認為,夜間治療之好處的可能解釋或許與夜間治療對尿液白蛋白分泌的影響有關。他們以前認為使用valsartan治療時,尿液白蛋白分泌在睡覺後顯著降低,白天則沒有這樣的情況;此外,這與血壓的24小時變化無關,但是和睡覺時的血壓降低有關。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6639&x_classno=0&x_chkdelpoint=Y
  

BP Medications More Effective When Given at Night

By Emma Hitt, PhD
Medscape Medical News

October 26, 2011 — Among patients with chronic kidney disease (CKD) and hypertension, taking at least 1 antihypertensive medication at bedtime significantly improves blood pressure (BP) control, with an associated decrease in risk for cardiovascular events, according to new research.

Ramon C. Hermida, PhD, and colleagues from the Bioengineering and Chronobiology Laboratories at the University of Vigo, Campus Universitario, Spain, published their findings online October 24 in the Journal of the American Society of Nephrology.

According to the researchers, the beneficial effect of taking BP medication at night has been previously documented, but "the potential reduction in [cardiovascular disease (CVD)] risk associated with specifically reducing sleep-time BP is still a matter of debate."

The current prospective study sought to investigate in hypertensive patients with CKD whether bedtime treatment with hypertension medications better controls BP and reduces CVD risk compared with treatment on waking.

The study included 661 patients with CKD who were randomly assigned either to take all prescribed hypertension medications on awakening or to take at least 1 of them at bedtime. Ambulatory BP at 48 hours was measured at least once a year and/or at 3 months after any adjustment in treatment.

The composite measure of cardiovascular events used included death, myocardial infarction, angina pectoris, revascularization, heart failure, arterial occlusion of lower extremities, occlusion of the retinal artery, and stroke. The investigators controlled their results for sex, age, and diabetes.

Patients were followed for a median of 5.4 years; during that time, patients who took at least 1 BP-lowering medication at bedtime had approximately one third of the CVD risk compared with those who took all medications on awakening (adjusted hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.21 - 0.46; P < .001).

A similar significant reduction in risk with bedtime dosing was noted when the composite CVD outcome included only cardiovascular death, myocardial infarction, and stroke (adjusted HR, 0.28; 95% CI, 0.13 - 0.61; P < .001).

Patients taking their medications at bedtime also had a significantly lower mean BP while sleeping, and a greater proportion of these patients had ambulatory BP control (56% vs 45%; P = .003).

The researchers estimate that for each 5-mm-Hg decrease in mean sleep-time systolic BP, there was a 14% reduction in the risk for cardiovascular events during follow-up (P < .001).

According to Dr. Hermida and colleagues, "treatment at bedtime is the most cost-effective and simplest strategy of successfully achieving the therapeutic goals of adequate asleep BP reduction and preserving or re-establishing the normal 24-hour BP dipping pattern."

The authors suggest that a potential explanation for the benefit of nighttime treatment may be associated with the effect of nighttime treatment on urinary albumin excretion levels. "We previously demonstrated that urinary albumin excretion was significantly reduced after bedtime, but not morning, treatment with valsartan," they note. In addition, this reduction was independent of 24-hour changes of BP, but correlated with a decline in BP during sleep.

The study was not commercially supported. The authors and editorialists have disclosed no relevant financial relationships.

J Am Soc Nephrol. Published online October 24, 2011.

    
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