目的 探讨卡维地洛联合缬沙坦氢氯噻嗪治疗顽固性高血压的临床疗效。方法 选择2017年4月-2018年4月在延安大学附属医院治疗的顽固性高血压患者86例，根据用药差别分为对照组（43例）和治疗组（43例）。对照组口服缬沙坦氢氯噻嗪片，1片/次，1次/d；治疗组在对照组基础上口服卡维地洛片，起始6.25 mg/次，2次/d，根据血压情况成倍增减剂量，最大剂量小于50 mg/d。两组患者均治疗4周。观察两组患者临床疗效，同时比较治疗前后两组患者血压、HAMA评分、HAMD评分、SPIEGEL评分、SF-36评分、肱动脉内皮依赖性舒张功能（EDD）、肱动脉非内皮依赖的舒张功能（NMD）及血清C反应蛋白（CRP）、同型半胱氨酸（Hcy）、内皮素-1（ET-1）、血管性血友病因子（vWF）和血管紧张素Ⅱ（AngⅡ）水平。结果 治疗后，对照组临床有效率为79.07%，显著低于治疗组的95.35%，两组比较差异具有统计学意义（P<0.05）。经治疗，两组患者SBP、DBP均明显下降（P<0.05），且治疗组患者收缩压（SBP）、舒张压（DBP）明显低于对照组患者（P<0.05）。经治疗，两组HAMA、HAMD和SPIEGEL评分明显降低（P<0.05），SF-36评分明显升高（P<0.05），且治疗组患者HAMA、HAMD、SPIEGEL和SF-36评分明显优于对照组患者（P<0.05）。经治疗，两组患者EDD、NMD均明显升高（P<0.05），且治疗组患者EDD、NMD明显高于对照组患者（P<0.05）。经治疗，两组患者血清CRP、Hcy、ET-1、vWF、AngⅡ均明显降低（P<0.05），且治疗组患者上述血清细胞因子明显低于对照组（P<0.05）。结论 卡维地洛片联合缬沙坦氢氯噻嗪片治疗顽固性高血压可有效降低患者血压水平，促进血管内皮功能改善，改善患者焦虑、抑郁情绪，促进患者睡眠及生活质量提高。

Objective To investigate the clinical efficacy of carvedilol combined with valsartan hydrochlorothiazide in treatment of refractory hypertension. Methods Patients (86 cases) with refractory hypertension in Yan'an University Affiliated Hospital from April 2017 to April 2018 were divided into control (43 cases) and treatment (43 cases) groups based on different treatments. Patients in the control group were po administered with Valsartan and Hydrochlorothiazide Tablets, 1 tablet/time, once daily. Patients in the treatment group were po administered with Carvedilol Tablets on the basis of the control group, the initial dose was 6.25 mg/time, twice daily. The dose was increased or decreased according to blood pressure, and the maximum dose was less than 50 mg/d. Patients in two groups were treated for 4 weeks. After treatment, the clinical efficacy was evaluated, and the blood pressure, HAMA scores, HAMD scores, SPIEGEL scores, SF-36 scores, EDD, NMD, and serum CRP, Hcy, ET-, vWF and AngⅡ levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 79.07%, which was significantly lower than 95.35% in the treatment group, and there were differences between two groups (P<0.05). After treatment, the SBP and DBP in two groups were significantly decreased (P<0.05), and SBP and DBP in the treatment group were significantly lower than those in the control group (P<0.05). After treatment, the HAMA, HAMD and SPIEGEL scores in two groups were significantly decreased (P<0.05), but SF-36 scores were significantly increased (P<0.05), and these scores in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the EDD and NMD in two groups were significantly increased (P<0.05), and EDD and NMD in the treatment group were significantly higher than those in the control group (P<0.05).After treatment, the serum CRP, Hcy, ET-1, vWF and AngⅡ levels in two groups were significantly decreased (P<0.05), and these serological indexes in the treatment group were significantly lower than those in the control group (P<0.05). Conclusion Carvedilol combined with valsartan and hydrochlorothiazide in treatment of refractory hypertension can effectively reduce the blood pressure level, promote the improvement of vascular endothelial function, improve anxiety and depression, promote sleep and quality of life of patients.

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