综合干预对高血压患者左室肥厚、冠状动脉钙化和动脉内皮功能的影响

Influence of combination intervention on left ventricular remodeling,endothelial function and coronary atherosclerosis in hypertension patients

目的： 探讨联合降压治疗与适当调脂综合干预对原发性高血压患者内皮功能、左心室重构、冠状动脉粥样硬化的影响.方法：入选50-79岁原发性高血压200例,随机分为：A组（49例）：使用小剂量氨氯地平（2.5 mg/d）＋替米沙坦（40 mg/d）,B组（51例）：使用小剂量氨氯地平＋复方阿米洛利（复方利尿剂,半片/d）,C组（48例）：在A组基础上加小剂量辛伐他汀（10mg/d）,D组（52例）：在B组基础上加辛伐他汀（10mg/d）.A组及B组患者治疗12个月前后各检查一次超声心动图,C组及D组患者,测定治疗12个月前后血浆血管紧张素酶（ACE）活性、血管紧张素Ⅱ（AngⅡ）浓度、肱动脉内皮依赖性舒张功能（FMD）及冠状动脉斑块的变化情况.结果：（1）A组患者的左室后壁厚度[LVWPT,（ 1.09±0.21） cm∶（ 1.27±0.28） cm]与室间隔厚度[IVST,（1.09±0.27） cm∶（ 1.28±0.31） cm]在治疗12月后较治疗前显著下降（P均〈0.05）,而左室重量[LVM,（205.23±62.04）g∶（ 263.97±98.06）g]及左室重量指数[LVMI,（ 128.13±34.15） g/m2∶（ 164.98±60.33） g/m2]下降更显著（P均〈0.01）;FMD明显改善[（5.6±4.2）%∶（ 4.3±2.7）%,P〈0.05];（2）较之B组,A组的LVM[（225.23±72.8）g∶ （205.23±62.04）g],LVMI[（139.27±37.26） g/m2∶ （ 128.13±34.15） g/m2]下降更加显著,FMD[（4.8±3.7） %∶（5.6±4.2） %]提高更显著,P均〈0.05;（3）C组及D组患者用小剂量辛伐他汀治疗l2月后,血清TC、LDL-C、ACE活性、AngⅡ浓度、冠脉钙化积分对数值均显著下降（P均〈0.01）,且分别较A组,B组显著下降（P〈0.05～〈0.01）,但C、D两组无显著差异（P〉0.05）.结论：原发性高血压患者在小剂量氨氯地平＋替米沙坦或复方阿米洛利治疗12月后可使左室肥厚显著逆转;对左室肥厚、动脉内皮功能的作用,替米沙坦优于复方阿米洛利;加用小剂量辛伐他汀可使冠脉钙化积分下降,有防治冠状动脉粥样硬化的作用.

Objective： To evaluate the influence of combination intervention on left ventricular remodeling, endothelial function, and coronary atherosclerosis in hypertension patients. Methods： A total of 200 essential hypertension（EH） patients were enrolled and randomly divided into four groups： A, B, C and D group. Patients in group A received low -dose amlodipine （2.5mg/d） and telmisartan （40mg/d）. group B had low-dose amlodipine and compound amiloride （compound diuretic, half tablet/d）, group C had simvastatin（10mg/d）above the treat base of groups A, while group D bad simvastatin（10mg/d）above the treat base of groups B. The echocardiography , flow-mediated dilation of brachial artery（FMD）were examined in group A and B, the serum angiotensin converting enzyme （ACE） activity, angiotensin （Ang） II concentration, and CT coronary calcification determined by 64-slice spiral were examined in group C and D at baseline and 12 months after therapy. Results： After 12 months therapy the LVWPT[ （1.09±0.21） cm vs. （ 1.27 ±0.28） cm], IVST [ （1.09±0.27） cm vs. （1.28±0.31） cm]significantly decreased （P〈0.05 all）, but LVM [（205.23±62.04）g vs. （ 263.97±98. 06）g]]and LVMI[（128.13±34.15） g/m^2 vs. （ 164. 98±60. aa） g/m^2] decreased more （P〈0.01 all） ;FMD[（5. 6±4. 2）% vs. （4.3±2.7） %]increased（P〈0.05） compared with before therapy in group A; （2）Compared with group B, the LVM[（225.23±72.8）g vs. （205.23±62.04）g],LVMI[（139.27± 37.26） g/m^2 vs. （ 128. 13±34.15） g/m^2] decreased more , FMD[（4. 8±3.7） % vs. （5.6±4.2） %] increased more （P〈0.05 all）in group A; （3）In group C and D （contain low-dose simvastatin therapy）, 12 months after therapy the serum TC,LDL-C level, ACE activity, Ang Ⅱ concentration, coronary calcification integral all significantly decreased （P〈0.01 all） , and decreased more than those of group A and B （P〈0.05-〈0. 01）, but those were no significant difference between group C and group D （P〉0.05）. Conelusion： Amlodipine, telmisartan and compound amiloride can significantly reverse the left ventrieular hypertrophy and improve endothelial function; for left ventrieular hypertrophy and function, telmisartan has superior effect than compound amiloride; low-dose simvastatin plays an important role in prevention of coronary atherosclerosis in essential hypertension patients.