高血压合并心力衰竭患者应用ACEI和ACEI联合ARB的随机对照研究

A randomized comparative study of ACEI and combinated treatment with ACEI and ARB in hypertensive patients with heart failure

目的 探讨高血压合并心力衰竭的患者治疗中联合应用血管紧张素转换酶抑制剂（ACEI）和血管紧张素Ⅱ受体拈抗剂（ARB）的安全性和对心功能的影响。方法 自2005年2月-2006年2月扎入选91例高血压合并心力衰竭患者．采用随机对照方法，将入选患者分为ACEI组46例和ACH联合ARB组45例。2组均应用氢氯噻嗪25mg／d，用药前血钾、肝功能、肾功能均正常．ACEI组给予培哚普利。4mg／d；ACEI联合ARB组给予培哚普利。4mg／d，缬沙坦80mg／d，均以血压降至140／90mmHg以下为达标。监测用药1个月前后的血钾、C反心蛋白（CRP）、血肌酐水平及心功能变化。，结果（1）未见血钾及咀肌酐的异常增高。（2）与治疗前比较，2组患者治疗后血浆CRP浓度差异有显著意义（P〈0．05）．2组间比较亦有显著差异（P〈0．05）。（3）2组患者治疗后心脏收缩功能改变差异有显著意义（P〈0．05）．但2组间比较尤显著差异（P〉0．05）。（4）2组治疗前后心室舒张功能改变差异有显著意义（P〈0．05）。2组间比较亦有显著差异（P〈0．05）。结论 在应用排钾利尿剂的基础上，联合应用ACEI和ARB冶疗高血压合并心力衰竭的患者，小但可以增加控制高血压的疗效，而且不会导致血钾、血肌酐水平的异常增高，并且町降低血清CRP浓度。在改善心脏收缩功能的同时，明显改善心脏的舒张功能。

Objective To evaluate the safty and efficacy of ACEI and combinated with ACEI and ARB for bypertensive patients with heart failure. Methods From Feb. 2005 to Feb. 2006,91 hypertensive patients with heart failure were randomized to receive ACEI （ perindopril,4 rag/day, n = 46） and combinated with ACEI and ARB （perindopril,4 mg/day ; Valsartan,80 mg/day, n = 45 ）. All patients taken hydrochlorothiazide （25 mg/day ）. Heart function, senan creatinine, CRP and eleetrolytes were measured before, l month after treatment. Results （ 1 ） No one was higher in the level of K＇ and e.reatinine after treatment. （2） There was significantly difference in the level of CRP between before and after treatment （ P 〈 0.05 ）. Differences of CRP were found between two groups （ P 〈 0.05 ） after treatment. （3） The systolic function was significantly different after treatment （ P 〈 0.05 ）. Otherwise, no difference was tound between two groups （ P 〉 0.05 ）. （4） Differences of the diastolic function were found between before and after treatment （ P 〈 0. 05 ）. There was difference between two groups after treatment （ P 〈 0.05）. Conclusion Our results suggest that combinated tratment with ACEI and ARB on hypertensive patients with heart failure is effective and safe by taken hydrochlorothiazide in the meantime. Combinated treatment with ACEI ard ARB can improve the effect in control of hypertension. That did not increase serum K ＋ and ereatinine levels. CRP was significantly reduced compared to the ACEI group ＇after treatment. So, combinated treatment with ACEI and ARB can improve heart funclion, especialy diastolic fimction.