卡维地洛长期治疗对原发性高血压左心室肥厚及室性心律失常干预的对比研究

Effects of carvedilol on left ventricular hypertrophy and ventricular arrhythmia in patients with essential hypertension

目的探讨β及α受体阻滞剂卡维地洛对原发性高血压(EH)患者左心室肥厚(LVH)及室性心律失常(VA)的干预作用.方法入选经超声心动图、心电图、动态心电图检查证实为EH伴LVH及VA患者72例,随机分配到卡维地洛组(口服25～50mg/d)或卡托普利组(口服25～75mg/d),治疗8个月,治疗前后各检查超声心动图、心电图、动态心电图,对比分析组内治疗前后左心室重量指数及VA变化和两组间的差异.结果①与治疗前比较,EH患者在卡维地洛或卡托普利治疗8个月后,两组收缩压与舒张压明显下降(166/104mmHg至135/86mmHg;162/103mmHg至138/87mmHg)(P均＜0.01).②卡维地洛组治疗后,左心室后壁与室间隔厚度较治疗前显著下降(P＜0.05),左心室重量及左心室重量指数下降更显著(P均＜0.01);卡托普利组治疗后左心室后壁与室间隔厚度及左心室重量及左心室重量指数下降显著(P均＜0.05).③卡维地洛组治疗后VA及复杂性室性VA的控制率为91.67%(33/36);卡托普利组治疗后VA及复杂性VA的控制率为36.1%(13/36),两组间差异有显著性(P＜0.01).结论EH伴LVH及VA患者在卡维地洛治疗8个月后LVH显著逆转,卡维地洛对VA的干预明显优于卡托普利.

Objective To explore the effect of Carvedilol on left ventrieular hypertrophy（LVH） and ventricular arrhythmia （VA） in patients with hypertension. Methods Seventy-two patients with essential hypertension and LVH ＆ VA revealed by echocardiography and 12-lead synchronous resting electrocardiogram, ambulatory electrocardiogram entered the study. Patients were randomized into the carvedilol [ 25 --50mg/d） group or captopril [ 25 -- 75mg/d ） group, and treated for 8 months. Echocardiography and 12-lead synchronous resting electrocardiogram, ambulatory electrocardiogram before and 8 months after treament were conducted. Results Eight months after treatment with carvedilol or captopril, blood pressure was reduced from 166/104mmHg to 135/86mmHg （ P 〈 0.01 ） or from 161/102mmHg to 139/89mmHg（ P 〈 0.01 ）, respectively. Left ventricular mass index decreased from （ 163.58 ± 59.43 ） g/m^2 to （ 130.26 ± 32.15 ） g/m^2 （ P 〈 0.01 ） or from （ 162.75 ± 47.36 ） g/m^2 to （ 137.54 ± 38.63 ） g/m^2 （ P 〈 0.05 ）, respectively. The disappearance of ventricular arrhythmia （VA） was found in 91.67% in carvedilol group but not changed in captopril group. Conclusion Long-term treatment with resulted in a significant reduction of LVH and VA in patients with essential hypertension.