超声评价血管紧张素转换酶抑制剂及血管紧张素受体拮抗剂对高血压左室肥厚患者冠状动脉血流动力学的影响

Doppler ultrasound in evaluating effects of angiotensin converting enzyme inhibition or angiotensin II receptor blocker on coronary hemodynamics in hypertensive patients with left ventricular hypertrophy

目的 应用超声技术评价血管紧张素转换酶抑制剂雷米普利和血管紧张素受体拮抗剂氯沙坦及联合用药对高血压左室肥厚患者冠状动脉血流动力学的影响。方法 将 60例高血压合并左室肥厚的患者随机分入雷米普利、氯沙坦单用和二者联合用药组 ,治疗 6个月后复查 ,采用多平面经食管超声心动图和动态三维超声心动图评价用药前后左室质量 (LVM )和冠状动脉血流动力学的变化。结果 最终共 5 0例患者完成了全部检查。治疗 6个月后 ,雷米普利组、氯沙坦组及联合用药组收缩压、舒张压均显著下降 ,LVM明显减轻 (P均 <0 .0 1) ;雷米普利组、氯沙坦组和联合用药组均见冠状动脉前降支近端经LVM校正的舒张期血流流速积分(DVic)较用药前显著增高 ,收缩期血流流速积分 (SVic)降低 (P均 <0 .0 1) ;静脉注射双嘧达莫后 ,经LVM校正后的SVic、DVic 在雷米普利组、氯沙坦组和联合用药组均见治疗后较治疗前显著增高 (P <0 .0 5～ 0 .0 1) ;氯沙坦组和联合用药组冠状动脉血流储备 (CFR)指标显著增加 (P <0 .0 5 ) ,经LVM校正后的上述指标增加程度更为显著 (P <0 .0 5～ 0 .0 1) ,且联合用药组CFR高于雷米普利组 (P <0 .0 5 ) ,雷米普利组仅见经LVM校正后的CFR指标较治疗前显著增加 (P <0 .0 5 )。结论 雷米普利和氯沙坦联合用药?

Objective To evaluate the effects of angiotensin converting enzyme inhibition(ACEI) or angiotensin II receptor blocker(ARB) on coronary hemodynamics in hypertensive patients with left ventricular hypertrophy(LVH) by Doppler ultrasound.Methods Sixty essential hypertensive patients with LVH were enrolled in this study.All patients were randomly divided into 3 groups: ramipril group,losartan group and combination group.Left ventricular mass(LVM) was calculated by three dimensional echocardiography and coronary hemodynamics was evaluated by transesophageal echocardiography with left anterior descending artery.Coronary flow reserve(CFR) was calculated as the ratio of coronary flow velocity,after intravenous injection of dipyridamole,to rest peak velocity.All the indexes of the coronary hemodynamics were corrected by LVM.Results Fifty patients had complete follow up datum.The systolic blood pressure(SBP),diastolic blood pressure(DBP) and LVM were significantly decreased in ramipril,losartan and combination group after 6 months′ treatment (All P< 0.01 ).Compared with baseline,diastolic flow velocity integral corrected by LVM (DVi c, 0.01 cm/g) was increased (All P< 0.01 ) while systolic flow velocity integral (SVi c, 0.01 cm/g) was decreased (P< 0.01 ) in ramipril,losartan and combination group at rest.SVi c and DVi c were increased in all three groups after intravenous injection of dipyridamole (P< 0.05 0.01 ).Compared with baseline,CFR increased in losartan group and combination group, while the corrected indexes of CFR increased more significantly(P< 0.05 0.01 ).Only corrected indexes of CFR increased in ramipril group(P< 0.05 ).After treatment,CFR of combination group was higher than that of ramipril group.Conclusions Combined administration of 1/2 doses of ACEI and ARB shows an equal effect on reducing blood pressure and regressing LVH to single drug intake and more effective effects on the improvement of coronary hemohynamics.