摘要
目的研究缬沙坦、苯那普利、非洛地平的降压效果,对高血压左室肥厚(LVH)的逆转作用并观察治疗中的醛固酮(Ald)逃逸现象与LVH关系。方法入选高血压左室肥厚患者111例随机分成服用缬沙坦组(36例)或苯那普利组(39例)或非洛地平组(36例),监测治疗过程中的血压变化及服药10~14周、20~26周时血浆血管紧张素Ⅱ(AngⅡ)、醛固酮(Ald)变化,治疗前后超声心动图检查及检测血尿常规、血糖、血脂、肝肾功能检查,记录药物不良反应。结果3组均能有效降压,效果相当(组内治疗前后比较,P<0.01,组间比较,P>0.05)。缬沙坦组、苯那普利组均能逆转LVH。左室质量(LVM)、左室质量指数(LVMI)下降(组内治疗前后比较P<0.01;组间P>0.05),舒张功能改善,二尖瓣血流舒张早期与晚期最大流速比值(E/A)升高(组内治疗前后比较,P<0.01;组间比较,P>0.05);非洛地平组虽有LVM下降(P<0.05),但LVMI、E/A无明显变化(P>0.05)。缬沙坦组治疗后AngⅡ显著上升(P<0.01);苯那普利组治疗10~14周AngⅡ明显下降(P<0.01),20~26周Ald升高,接近治疗前水平(P>0.05),与10~14周比较明显升高(P<0.01);非洛地平组AngⅡ较治疗前显著上升(P<0.01)。缬沙坦组治疗后Ald浓度明显下降(P<0.01)。苯那普利组Ald逃逸发生率36%,有逃逸者LVH逆转较差。结论缬沙坦、苯那普利、非洛地平降压效果相当。3组对LVH均有逆转作用。缬沙坦、苯那普利作用优于非洛地平。缬沙坦长期应用无Ald逃逸。非洛地平治疗期间对血浆Ald无明显影响。
Objective To compare the efficacy of valsartan,benazepril and felodipine on reversal of left ventricular hypertrophy(LVH)in patients with hypertension and the relevant "aldosterone escape phenomena".Methods One hundred eleven patients with hypertension-related LVH were randomly to receive valsartan(80-160 mg/d,n=36),benazepril(10-20 mg/d,n=39)and felodipine(5 mg/d,n=36).Plasma angiotensin Ⅱ(Ang Ⅱ)and aldosterone(Ald)were determined before and 10-14 weeks 20-26 weeks after treatment.Echocardiographic examinations and blood routine,urine routine,blood glucose,blood lipid,liver function and renal function were conducted in all subjects before and after treatment.Results Blood pressure was significantly decreased in all three groups(P〈0.01)with no defferences was found among them.Both valsartan treatment group and benazepril treatment reversed LVH;reduced left ventricular mass(LVM)and left ventricular mass index(LVMI)(P〈0.01)and increased E/A ratio(P〈0.01);while felodipine only decreased LVM(P〈0.05)with no changes in LVMI and E/A ratio(P〉0.05).Valsartan increased plasma Ang Ⅱ at 10-14 weeks and furthermore at 20-26 weeks;benazepril decreased plasma Ang Ⅱ initiatively with trend of rebound at 20-26 weeks;however,plasma Ang Ⅱ was kept constantly in felodipine group.Valsartan decreased Ald and sustained during the all treatment period.On contrary,benazepril initiatively decreased Ald which was rebound to baseline level at 20-26 weeks.No change in Ald by felodipine was found during the treatment.After treatment plasma Ald level was significantly related to the reduction of LVH in both valsartan and benazepril groups.36% patients in benazepril group was found to have "aldosterone escape".Conclusion The antihypertensive effect was similar between valsartan,benazepril and felodipine.Although three medications all reversed LVH,but valsartan,benazepril was more effective than felodipine.There was no evidence of aldosterone escape in the long-term treatment with valsartan.Valsartan might have more advantages in reversal of LVH than benazepril.Felodipine had no effect on the plasma level of aldosterone.
出处
《中华高血压杂志》
CAS
CSCD
北大核心
2007年第8期641-644,共4页
Chinese Journal of Hypertension
关键词
缬沙坦
苯那普利
非洛地平
左室肥厚
醛固酮逃逸
Valsartan
Benazepril
Felodipine
Essential hypertension
Left Ventricular Hypertrophy
Aldosterone escape