目的 探讨米氮平联合氨氯地平治疗老年高血压伴焦虑抑郁的临床疗效。方法 收集2012年10月-2015年10月新乡医学院第二附属医院收治的老年高血压伴焦虑抑郁患者85例，随机分为对照组（42例）和治疗组（43例）。对照组患者睡前口服苯磺酸氨氯地平片，5 mg/次，1次/d。治疗组在对照组的基础上早晨口服米氮平片，起始量为15 mg，1次/d，1周内根据患者情况酌情加至30 mg。两组患者均连续治疗12周。观察两组患者降压疗效和血压水平，比较两组治疗前后汉密尔顿抑郁量表（HAMD）评分、汉密尔顿焦虑量表（HAMA）评分和生活质量评价量表（SF-36）评分的变化。结果 治疗后，对照组总有效率为69.05%，治疗组总有效率为90.70%，两组总有效率比较差异具有统计学意义（P<0.05）。治疗后，两组患者收缩压、舒张压均显著降低（P<0.05）；与对照组相比，治疗后治疗组血压下降更为明显，两组比较差异具有统计学意义（P<0.05）。治疗4、8、12周后，治疗组患者HAMD和HAMA评分显著降低，同治疗前比较差异有统计学意义（P<0.05）；且治疗组上述评分低于对照组，两组比较差异有统计学意义（P<0.05）。治疗后，两组患者SF-36各项评分均得到改善，同组治疗前后差异具有统计学意义（P<0.05）；且除社会功能评分外，治疗后治疗组其余SF-36评分高于对照组，两组比较差异具有统计学意义（P<0.05）。结论 米氮平联合氨氯地平治疗老年高血压伴焦虑抑郁能提高氨氯地平的降压效果，改善患者的心理状态，提高生活质量。

Objective To observe the clinical curative effect of mirtazapine combined with amlodipine in treatment of senile hypertension with anxiety and depression. Methods Patients (85 cases) with elderly hypertension with anxiety and depression in The Second Affiliated Hospital of Xinxiang Medical University from October 2012 to October 2015 were randomly divided into control (42 cases) and treatment (43 cases) groups. The patients in the control group were po administered with Amlodipine Besylate Tablets before sleeping, 5 mg/time, once daily. The patients in the treatment group were po administered with Mirtazapine Tablets in the morning on the basis of the control group, the initial dose was 15 mg and added to 30 mg according to the patient's condition within one week, once daily. The patients in two groups were treated for 12 weeks. After treatment, the antihypertensive efficacy and blood pressure level were evaluated, and the changes of HAMD, HAMA, and SF-36 scores in two groups before and after treatment were compared. Results After treatment, the efficacies in the control and treatment groups were 69.05% and 90.70%, respectively, and there were differences between two groups (P<0.05). After treatment, systolic and diastolic blood pressure in two groups were significantly decreased (P<0.05). Compared with the control group, the blood pressure level in the treatment group was lower than those in the control group, with significant difference between two groups (P<0.05). After treatment for 4, 8, and 12 weeks, HAMD and HAMA scores in the treatment group were significantly decreased, and the difference was statistically significant in the treatment group before and after treatment (P<0.05). And these scores in the treatment group were lower than those in the control group, with significant difference between two groups (P<0.05). After treatment, the SF-36 scores in two groups were significantly improved, and the difference was statistically significant in the same group (P<0.05). And except the social function score, the other SF-36 scores in the treatment group were higher than those in the control group, with significant difference between two groups (P<0.05). Conclusion Mirtazapine combined with amlodipine has good efficacies in treatment of elderly hypertension with anxiety and depression and can improve the antihypertensive efficacy of amlodipine, the psychological status of patients, and quality of life.

河南省卫生科技创新型人才工程专项（YWZY201348）