| ObjectiveTo evaluate the efficacy of eszopiclone in improving sleep,and to determine whether zopiclazole can increase the antihypertensive effect,which improves sleep in patients with moderate to severe essential hypertension with insomnia.Methods90 patients with moderate essential hypertension and 90 patients with severe essential hypertension are collected.These patients from the Center Hospital Affiliated of Shenyang Medical College from December 2017 to May 2018 have essential hypertension with insomnia[Pittsburgh Sleep Quality Index(PSQI)>7 points].According to the blood pressure level,the eligible patients were divided into two subgroups:moderate(grade 2)hypertension group and severe(grade 3)hypertension group.Each subgroup was randomly di'vided into control group(oral amlodipine besylate and valsartan + Placebo)and experimental group(oral amlodipine besylate and valsartan+eszopiclone),each group of patients were treated for 30 days.24-hour Ambulatory Blood Pressure Monitoring(ABPM)and PSQI were taken before treatment and 14 days and 30 days after treatment.All patients were observed for all day average systolic blood pressure(ADASBP),all day average diastolic blood pressure(ADADBP),all day average heart rate(ADAHR)and improvement of insomnia.Results1.Follow-up(1)Moderate hypertension subgroup:45 patients selected in the control group.After 30 days of follow-up,1 case was lost to follow-up,2 cases were withdrawn,and the remaining 42 cases were completed.The experimental group was enrolled in 45 cases.After 30 days of follow-up,0 cases were lost,1 case was withdrawn and the remaining 44 cases were observed.(2)Severe hypertension subgroup:45 cases were selected in the control group.After 30 days of follow-up,0 cases were lost to follow-up,2 cases were withdrawn,and the remaining 43 cases were completed.The experimental group was enrolled in 45 cases.After 30 days of follow-up,1 case was lost.1 case was withdrawn and the remaining 43 cases were observed.2.Comparison of baseline characteristics of patientsBetween the control group and the experimental group,There were no significant association in the baseline characteristics included in age,gender,duration of hypertension,insomnia,PSQI,ADASBP,ADADBP,ADAHR(P>0.05).3.Comparison of PSQI,ADASBP,ADADBP and ADAHR before and after treatment in each group of patients(1)Moderate essential hypertension subgroupThe four indexes of the control group before treatment,14 days and 30 days:PSQI(15.76±2.06;15.05±1.91;14.74±1.91),ADASBP(153.86±6.68mmHg;144.29±6.23mmHg;139.14±5.22mmHg),ADADABP(94.90±5.47mmHg;88.43±5.11mmHg;84.62±4.68mmHg)and ADAHR(83.07±5.65bpm;82.05±5.69bpm;80.12±5.60bpm).Compared with before treatment,PSQI and ADAHR decreased after 30 days of treatment(P<0.05);Compared with before treatment,ADASBP and ADADBP were significantly decreased after 14 days of treatment(P<0.01)and further decreased after 30 days of treatment(P<0.01),Compared with 14 days of treatment,both treatments decreased for 30 days(P<0.01).The four indexes of the experimental group before treatment,14 days and 30 days:PSQI(15.30±2.13;11.82±2.07;8.98±1.72),ADASBP(154.27±5.69mmHg;141.57±5.63mmHg;136.02±4.97mmHg),ADADABP(93.84±6.19mmHg;85.55±5.20 mmHg;82.41±5.29 mmHg)and ADAHR(83.93±5.26bpm;78.14±5.27bpm;72.25±5.69bpm).Compared with before treatment,PSQI and ADAHR were significantly decreased after 14 days of treatment(P<0.01)and further decreased after 30 days of treatment(P<0.01).Compared with 14 days of treatment,both treatments decreased for 30 days(P<0.01);Compared with before treatment,ADASBP and ADADBP were significantly decreased after 14 days of treatment(P<0.01)and further decreased after 30 days of treatment(P<0.01).Compared with 14 days of treatment,both treatments decreased for 30 days(P<0.01).Comparison of the above four indicators between the control group and the experimental group for 14 days and 30 days of treatment:After 14 days of PSQI,the experimental group was lower than the control group(11.82±2.07 vs.15.05±1.91,P<0.01);After 30 days of PSQI,The experimental group was significantly lower than the control group(8.98±1.72 vs.14.74±1.91,P<0.01).After 14 days of ADASBP,the experimental group was lower than the control group(141.57±5.63mmHg vs.144.29±6.23mmHg,P<0.05);After 30 days of ADASBP,the experimental group was significantly lower than the control group(136.02±4.97mmHg vs,139.14±5.22mmHg,P<0.01).After 14 days of ADADBP,the experimental group was lower than the control group(85.55±5.20mmHg vs.88.43±5.11mmHg,P<0.05);After 30 days of ADADBP,the experimental group was significantly lower than the control group(82.41±5.29mmHg vs.84.62±4.68mmHg,P<0.05).After 14 days of ADAHR,the experimental group was lower than the control group(78.14±5.27bom vs.82.05±5.69bpm,P<0.01);After 30 days of ADAHR,the experimental group was significantly lower than the control group(72.25±5.69bpm vs.80.12±5.60bpm,P<0.01).(2)Severe essential hypertension subgroupThe four indexes of the control group before treatment,14 days and 30 days:PSQI(17.14±1.42;16.86±1.21;16.49±1.24),ADASBP(168.30±8.52mmHg;1 57.28±7.63mmHg;149.47±8.86mmHg),ADADBP(99.1 9±5.37mmHg;91.95±4.40mmHg;87.70±4.35mmHg)and ADAHR(87.42±5.96bpm;86.37±6.28bpm;84.33±5.84bpm).Compared with before treatment,PSQI and ADAHR decreased after 30 days of treatment(P<0.05);ADASBP and ADADBP were significantly decreased after 14 days of treatment(P<0.01)and further decreased after 30 days of treatment(P<0.01).Compared with 14 days of treatment,both treatments decreased for 30 days(P<0.01).The four indexes of the experimental group before treatment,14 days and 30 days:PSQI(17.09±1.51;14.47±1.79;10.91±1.51),ADASBP(169.1 6±8.59mmHg;153.23±7.93mmHg;144.16±7.73mmHg),ADADBP(97.72±7.01mmHg;88.02±6.61mmHg;83.33±6.39mmHg)and ADAHR(87.79±5.65bpm;82.23±5.69bpm;74.26±5.62bpm).Compared with before treatment,PSQI and ADAHR were significantly decreased after 14 days of treatment(P<0.01)and further decreased after 30 days of treatment(P<0.01).Compared with 14 days of treatment,both treatments decreased for 30 days(P<0.01);Compared with before treatment,ADASBP and ADADBP were significantly decreased after 14 days of treatment(P<0.01)and further decreased after 30 days of treatment(P<0.01).Compared with 14 days of treatment,both treatments decreased for 30 days(P<0.01).Comparison of the above four indicators between the control group and the experimental group for 14 days and 30 days of treatment:After 14 days of PSQI,the experimental group was lower than the control group(14.47±1.79 vs.16.86±1.21,P<0.01);After 30 days of PSQI,The experimental group was significantly lower than the control group(10.91±1.51 vs.16.49±1.24,P<0.01).After 14 days of ADASBP,the experimental group was lower than the control group(153.23±7.93mmHg vs.157.28±7.63mmHg,P<0.05);after 30 days of ADASBP,the experimental group was significantly lower than the control group(144.16±7.73mmHg vs.149.47±8.86mmHg,P<0.01).After 14 days of ADADBP,the experimental group was lower than the control group(88.02±6.61mmHg vs.91.95±4.40mmHg,.P<0.01).After 30 days of ADADBP,the experimental group was significantly lower than the control group(83.33±6.39mmHg vs.87.70±4.35mmHg,P<0.01).After 14 days of ADAHR,the experimental group was lower than the control group(82.23±5.69bpm vs.86.37±6.28bpm,P<0.01);After 30 days of ADAHR,the experimental group was significantly lower than the control group(74.26±5.62bpm vs.84.33±5.84bpm,P<0.01).Conclusion1.In patients with moderate to severe essential hypertension with insomnia,after oral administration of amlodipine besylate and valsartan,the quality of sleep gradually improved with the decrease of blood pressure,and statistical difference was formed at 30 days of treatment.2.Eszopiclone can effectively improve the sleep quality of insomnia patients,the effect is fast,the 14-day sleep quality is significantly improved,the effect of 30 days is better than 14 days.3.Amlodipine besylate combined with valsartan treatment has a better antihypertensive effect in patients with moderate to severe essential hypertension,and the effect of oral administration for 30 days is better than 14 days.4.For patients with moderate to severe essential hypertension with insomnia,oral administration of amlodipine besylate in combination with valsartan,and the use of Eszopiclone with improved sleep function can increase the original drop.The pressure reduction of ADASBP and ADADBP was better than that of the application for 14 days.5.Patients with moderate to severe essential hypertension with insomnia after oral administration of amlodipine besylate combined with valsartan antihypertensive treatment,with blood pressure decreased,heart rate gradually decreased,formed a statistical difference in 30 days of treatment. |
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