氢氯噻嗪与螺内酯或卡托普利长期合用对原发性高血压患者左室质量参数的影响

Effects of Long-term Treatment with Hydrochlorothiazide Combined Spironolactone or Captopril on Left Ventricular Hypertrophy in Hypertensive Patients

目的探讨氢氯噻嗪(HCTZ)与螺内酯或卡托普利长期联用对高血压病患者左室质量参数的影响。方法采用多中心随机双盲研究设计。选择9所开滦矿区医院,筛选出轻、中度高血压病患者。人选患者经安慰剂洗脱2周后随机分为螺内酯组(HCTZ 12.5 mg,1次/d+螺内酯20 mg,1次/d,n=112)和卡托普利组(HCTZ 12.5mg,1次/d+卡托普利25 mg,2次/d,n=109)。共服药36月。治疗期间每月随访1次,监测血压。洗脱期末和治疗12、24、36月末行超声心动图检查并计算左室质量指数(LVMI 或 LVMIh),采静脉血进行生化检查。结果 1)治疗12个月末,两组患者的 LVMI 均较治疗前显著下降(螺内酯组-8.9%,P<0.05;卡托普利组-12.6%,P<0.01);随治疗时间延长,两组患者的 LVMI 进一步下降(36月末与12月末比较,螺内酯组:-8.9%vs-17.5%,P<0.05;卡托普利组:-12.6%vs-19.2%,P>0.05),下降幅度组间比较无统计学意义(P>0.05);2)治疗12、24、36月末两组患者血压均显著下降(P<0.01),下降幅度组间比较,差异无统计学意义(P>0.05)。结论 HCTZ与螺内酯或卡托普利联用均能有效降低血压和 LVMI 或 LVMIh,且随治疗时间延长疗效更为显著。

Objective To explore the effects of long-term treatment with HCTZ combined spironolactone or captopril on left ventricular hypertrophy in hypertensive patients. Methods A multicentres, double-blind, randomized study was carried out in 9 hospitals. After 2-weeks＇ washout, the eligible patients with mild-to-moderate hypertension were randomly to receive spironolactone （HCTZ 12.5 mg qd＋spironolactone 20 mg qd, n=112 ） or captopril （HCTZ 12.5 mg qd＋captopril 25 mg bid, n=109） for 36 months. At the end of washouting period, 12, 24, 36 months, all subjects underwent echocardiographic study. Left ventricular mass index （LVMI or LVMIh） were determined by echocardiography. Results 1 ）After 12 months＇ treatment, both spironolactone/HCTZ and captopril/HCTZ significantly reduced LVMI （ spironolactone/HCTZ： - 8.9%, P〈0.05; captopril/HCTZ： - 12.6%, P〈0.01 ）, more significant reduction of LVMI by both combined treatments were shown with the extention of treatment from 12 months to 36 months （36 months vs 12 months, spironolactone/HCTZ： -8. 9% vs -17.5%, P〈0. 05; captopril/HCTZ： - 12.6% vs - 19.2%, P〉0. 05）, with no differences between two combinations groups （P〉0. 05）; 2）After 12, 24, 36 months＇ treatment, BP was decreased significantly in each group （P〈0. 01, respectively）, no siginificant intergroup differences were found （P〉0.05）. Conclusion Both combined spironolactone/HCTZ and captopril/HCTZ significantly reduced BP and LVMI or LVMI and the maguitude of reduction was further enhanced after prolonged treatment.