缬沙坦与胺碘酮联合应用减少原发性高血压合并心房颤动复发的临床研究

Clinical study of valsartan and aminodarone combination in reducing the recurrent rate of essential hypertension complicated with atrial fibrillation

目的探讨血管紧张素Ⅱ受体拮抗剂缬沙坦与抗心律失常药物胺碘酮联合应用是否可以减少原发性高血压合并心房颤动的复发。方法将原发性高血压合并持续性或阵发性房颤经电转复或药物恢复窦性心律的80例患者随机分为缬沙坦组（ARB组）与氨氯地平组（CCB组）。两组恢复窦律后均选用胺碘酮维持窦律，ARB组以缬沙坦80～160mg／d作为基础用药，CCB组以氨氯地平5～10mg／d作为基础用药，疗程为1年。观察两组患者1年内的房颤复发率。比较治疗前后左心室舒张末期室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、左心室舒张末期内径（LVEDd）、左心房前后径（LADd）、计算左心室质量指数（LVMI）及治疗期间心脑血管事件的发生情况。结果ARB组房颤复发率较CCB组明显降低（P〈0．05）。治疗后ARB组IVST、LVPWT、LVEDd、LADd、LVMI较治疗前均有明显下降（P〈0．01），CCB组只有IVST较治疗前有明显下降（P〈0．01）。两组治疗后IVST、LVPWT、LVEDd、LADd、LVMI比较差异均有统计学意义（P〈0．01或〈0．05）。治疗期间ARB组心脑血管事件的发生率明显低于CCB组（P〈0．01）。结论缬沙坦能够逆转原发性高血压引起的左心室肥厚，可以延缓左心房扩大，进而改善心房的电重塑与结构重塑，从而减少原发性高血压合并房颤的复发，降低房颤患者心脑血管事件的发生。

Objective To investigate the effects of valsartan and aminodarone combination in reducing the recurrent rate of essential hypertension complicated with atrial fibrillation （AF）. Methods Eighty patients with essential hypertension complicated with AF who were recovered the sinus rhythm through electrotherapy or medicines were randomly divided into two groups：valsartan （ARB） group and norvasc （CCB） group. Aminodarone were used in all patients to keep the sinus rhythm. Valsartan 80 - 160 mg/d was added in ARB group,and norvasc 5 - 10 mg/d was added in CCB group. At the one year,the recurrent rates of AF in two groups were compared. IVST, LVPWT, LVEDd, LADd, LVMI were measured in two groups before and after treatment by Doppler ultrasound. Results The recurrent rate of AF in ARB group decreased significantly compared with that in CCB group （P〈 0.05）. There was no significant difference in Doppler ultrasound index between the two groups before treatment, but after treatment IVST, LVPWT, LVEDd, LADd, LVMI in ARB group decreased significantly compared with that before treatment （P 〈 0.01 ）. In CCB group only IVST decreased significantly （P 〈 0.01）. The IVST,LVPWT, LVEDd,LADd,LVMI after treatment showed significant difference between the two groups （P 〈 0.01 or 〈 0.05）. At the one year,the recurrence rate of cardiocerebral events in ARB group was lower than that in CCB group （P 〈 0.01 ）. Conclusions Valsartan can reduce the recurrent rate of hypertension complicated with AF,and can effectively inhibit left ventricular remodeling, delay the enlargement of the left atrium. Valsartan is helpful in reducing the recurrent rate of cardiocerebral events in AF patients.