【摘要】 目的探讨长期降压治疗的依从性差异对不同血管紧张素转换酶(ACE)基因型高血压患者临床终点事件的影响。方法于2002年6月—2003年5月选择轻、中度高血压患者853例,入选患者经安慰剂洗脱2周和氢氯噻嗪(HCTZ)导入6周后随机给予HCTZ 12.5mg/d或HCTZ 12.5mg/d+螺内酯20mg/d或HCTZ 12.5mg/d+卡托普利25mg2次/d。治疗期间每月随访1次,监测血压,记录终点事件,每年进行生化指标检测,随访6年。根据患者的治疗依从性分为依从组和非依从组,比较不同依从组各基因型患者临床终点事件发生率。结果第6年时依从组发生临床终点事件20例(致死性2例,非致死性18例),低于非依从组61例(致死性15例,非致死性46例),差异有统计学意义(P<0.01)。依从组各基因型间累积发生事件率差别无统计学意义;而非依从组DD基因型的累积发生事件率最高(25.7%),ID型为15.4%,Ⅱ型为12.8%,且各基因型间发生率差异有统计学意义(P<0.05)。结论 ACE基因DD基因型是治疗依从性不良高血压患者发生临床心脑事件的危险因素,而良好的治疗依从性可减轻或消除DD基因型对心脑事件的不利影响。更多还原

【Abstract】 Objective To explore effect of medication compliance on the outcomes in hypertensive patients with different genotypes of angiotensin converting enzyme(ACE) gene.Methods A total of 853 patients with mild to moderate hypertension were randomized to receive one of therapies [hydrochlorothiazide(HCTZ)12.5mg q.d or HCTZ 12.5mg plus spironolactone 20mg q.d or HCTZ 12.5mg q.d plus captopril 25mg bid] after 2-week placebo washout period and 6-week loading period for HCTZ.Blood pressure and clinical outcomes were recorded monthly.Blood biochemical parameters were determined once a year.All patients had been followed up for 6 years.According to compliance with the therapy,the patients were divided into compliance group or non-compliance group.The incidences of cardio-cerebral vascular events were compared between different groups.Results By the end of 6-years follow-up period,frequencies of cardio-cerebral vascular events was significantly lower in compliance group(2 fatal,18 non-fatal) than that in non-compliance group(15 fatal,46 non-fatal,P<0.01).The incidence of cardio-cerebral vascular events among patients with different genotypes of ACE gene were no difference in compliance group(P>0.05),but it was significantly higher in patients with DD genotype than that in patients with II and ID genotypes in non-compliance group(P<0.05).Conclusion This study indicates that DD genotype of ACE gene is a risk factor of increasing incidence of cardio-cerebral vascular events among non-compliance hypertensive patients,but the risk can be reduced or eliminated among compliance patients.更多还原