咪达普利和缬沙坦联合治疗对原发性高血压患者左心室肥厚的逆转

Effects of combined treatment by imidapril and valsartan on essential hypertension patients with left ventricular hypertrophy

目的:探讨咪达普利和缬沙坦联合治疗对原发性高血压(EH)患者左心室肥厚(LVH)的逆转。方法:将137例伴LVH的EH患者随机分成咪达普利组、缬沙坦组和联合治疗组。设定血压达标值为收缩压(SBP)<140mmHg(1mmHg=0.133kPa)和舒张压(DBP)<90mmHg。3组患者分别口服起始剂量咪达普利10mg/d、缬沙坦80mg/d和咪达普利10mg/d加缬沙坦80mg/d。随访周期为2周,若血压未能达标,则增加剂量直至联合治疗,最大剂量为咪达普利20mg/d加缬沙坦160mg/d。3组患者均口服氢氯噻嗪12.5mg/d。总疗程24周。检测治疗前后24h动态血压、左室质量指数(LVMI)和心率(HR)。结果:①3组治疗后24hSBP、24hDBP均分别较治疗前显著降低(均P<0.01),而3组治疗前后24hSBP、DBP的降低幅度差异均无统计学意义(均P>0.05)。②3组治疗后LVMI和HR均分别较治疗前显著性降低(均P<0.01)。联合治疗组治疗前后LVMI和HR的降低幅度均分别大于咪达普利组和缬沙坦组,差别均具有统计学意义(均P<0.05)。结论:咪达普利和缬沙坦联合治疗在逆转LVH和抑制心脏交感活性方面较咪达普利或缬沙坦单药治疗具有更加显著的作用,且这些作用独立于降压疗效之外。

Objective：To examine the effects of combined treatment by imidapril and valsartan on essential hy pertension（EH） patients with left ventricuIar hypertrophy（LVH）. Method：A total of 137 EH patients with LVH were divided randomly into three groups： imidapril group received imidapril 10 mg per day, valsartan group received valsartan 80 mg per day, combined treatment group received imidapril 10 mg and valsartan 80 mg per day. All groups received dihydrochlorothiazide （DHCT） 12.5 mg per day. If patients＇ SBP still≥140 mmHg or DBP≥90 mmHg in the next two weeks, the dose of imidapril or valsartan would be increased to twice as before until BP fell to the normal base level （SBP〈140 mmHg and DBP〈90 mmHg）. The entire Treatment would last for 24 weeks. The 24-hour ambulatory blood pressure monitoring （ABPM）, left ventricular mass index （LVMI） and heart rate （HR） were examined before and after treatment for confirmming the efficacy of medication. Result： （1） The 24 h SBP and 24 h DBP of patients in three groups decreased significantly after treatment （all P〈0.01）, but there is not markedly difference in decreasing amplitude among the three groups （all P〉0.05）. （2）LVMI and HR of patients in three groups decreased significantly after treatment （all P〈0.01） and the decreasing amplitude of LVMI and HR of patients in combined treatment group were markedly higher than those of the other two groups （all P〈0.05）. Conclusion：Combined treatment by imidapril and valsartan has more intensive effect on reversing LVH and inhibiting sympathetic activity, comparing with single drug treatment. Above effects are independent of blood pressure depressing.