厄贝沙坦、硝苯地平及美托洛尔逆转高血压病左心室肥厚的效果观察

Comparative effects of irbesartan versus nifedipine GITS and metoprolol on left ventricular hypertrophy in hypertensive patients

目的比较厄贝沙坦、硝苯地平及美托洛尔治疗原发性高血压逆转左心室肥厚的作用。方法选择150例原发性高血压伴左心室肥厚患者，随机分为厄贝沙坦组（A组）、硝苯地平控释片（B组）及美托洛尔组（C组）各50例。全组患者未曾接受降压治疗（或仅用过利尿剂）或已停用降压药物3周以上。A组服用厄贝沙坦150～300mg，1次／d，B组服用硝苯地平控释片30～60mg，1次／d，c组服用美托洛尔25～50mg，2次／d；疗程均为24周。观察治疗前后血压及超声心动图变化。结果各组患者治疗后血压均显著降低（P〈0．01），组间降压幅度无明显统计学差异（P〉0．05）。各组患者治疗后舒张期左室后壁厚度、舒张期室间隔厚度、左室舒张末期内径及左室重量指数均有显著改善（P〈0．05，0．01）。而且A组左室重量指数下降优于B、C组（P〈0．05）。结论三种药物在有效降压的同时均可逆转左心室肥厚，厄贝沙坦对左心室肥厚的逆转作用相对更强。

Objective The aim of this study was to assess the effects of irbesartan, nifedipine gastrointestinal therapeutic system （GITS） and metoprolol on left ventrieular hypertrophy （LVH） determined by eehoeardiograph in patients with mild to moderate untreated hypertension. Methods One hundred and fifity hypertensive patients （ 102 men and 48 women） with left ventrieular hypertrophy were randomized to treat with irbesartan 150 - 300 mg once daily（ group A, 34men and 16 women） or nifedipine GITS 30 - 60 mg once daily （ group B ,33 men and 17 women） or metoprolol 25- 50 mg twice daily （group C, 35men and 15 women） for 24 weeks. The blood pressure was measured and the uhrasonie cardiogram examed at the baseline and the end. Results All three drugs reduced ambulatory and clinic BP, but have no significant differences in the pressure decreasing. After 6 months, eehoeardiographieally estimated end-diastolic left ventrieular post wall thickness（LVPWT） , interventrieular septal thickness （IVST） ,end-diastolic left ventrieular diameter （LVDd） and left ventrieular mass index（LVMI） were all improved （ P 〈 0.01 ）. However,the improvement of LVMI in the irbesartan-treated group was more obvious than that of other two groups in LVMI. Conclusion These results suggest that irbesartan,nifedipine and metoprolol all can significantly reduce BP and reverse LVH, but irbesartan is prior to nifedipine and metoprolol in reversing the LVH.