目的 探讨山菊降压片联合福辛普利治疗老年原发性高血压的临床效果。方法 选取2019年10月—2021年6月华北医疗健康集团峰峰总医院收治的136例老年原发性高血压患者，按随机数字表法将这136例患者分成对照组和治疗组，每组各68例。对照组口服福辛普利钠片，初始剂量10 mg/次，1次/d，连用4周后调整至40 mg/次，1次/d。治疗组在对照组基础上口服山菊降压片，5片/次，2次/d。两组均连续治疗12周。观察两组的临床疗效，比较两组治疗前后诊室血压参数[收缩压（SBP）、舒张压（DBP）、脉压差（PP）]、动态血压参数（24 h、白天、夜间、清晨4个时段的SBP和DBP值）及血清内皮素-1（ET-1）、一氧化氮（NO）、肿瘤坏死因子（TNF）-α、基质金属蛋白酶-9（MMP-9）和组织金属蛋白酶抑制物1（TIMP-1）水平。结果 治疗后，治疗组总有效率为94.1%，显著高于对照组的82.4%（P＜0.05）。治疗后，两组诊室SBP、DBP、PP值均显著低于治疗前（P＜0.05）；且治疗后，治疗组诊室SBP、DBP、PP值改善均显著优于对照组（P＜0.05）。治疗后，两组24 h、白天、夜间、清晨的SBP和DBP值较治疗前均显著下降（P＜0.05）；且治疗后，治疗组以上各项动态血压相关参数的改善效果较对照组更显著（P＜0.05）。治疗后，两组血清ET-1、TNF-α、MMP-9和TIMP-1水平均显著降低，血清NO水平均显著上升（P＜0.05）；且治疗后，治疗组血清ET-1、TNF-α、MMP-9和TIMP-1水平低于对照组，NO水平高于对照组（P＜0.05）。结论 山菊降压片联合福辛普利治疗老年原发性高血压可有效且平稳地控制患者血压，并能进一步降低血中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，值得临床推广。

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

邯郸市科学技术研究与发展计划项目（1623208102ZC）