卡托普利、培哚普利和硝苯地平对高血压心室肥厚患者的疗效和耐受性对比观察

The effecacy and acceptability of captopril,perindopril and nifedipine in the treatment of elderly hypertensive ventricular hypertrophy

目的观察卡托普利、培哚普利和硝苯地平对老年高血压心室肥厚患者的疗效和耐受性。方法９４例老年高血压心室肥厚患者随机分为卡托普利组（３０例）、培哚普利组（３２例）和硝苯地平组（３２例）。服用安慰剂２周后分别用药３个月，剂量递增。于实验前和用药前后分别测定血压、超声心动图左室质量指数（ＬＶＭＩ）和收缩功能、尿微白蛋白分泌率（ＡＥＲ）等生化指标，并记录药物副作用。结果用药后血压均有显著下降，３组间差异无显著性；ＬＶＭＩ，卡托普利组〔（１４２±２３）减至（１０３±２８）ｇ／ｍ２，Ｐ＜００５〕和培哚普利组〔（１５０±３０）减至（１１８±２６）ｇ／ｍ２，Ｐ＜００１〕均显著减低，硝苯地平组未见减低；血钾，卡托普利组〔（４３±０４）升至（４５±０３）ｍｍｏｌ／Ｌ，Ｐ＜００１〕和培哚普利组〔（４４±０３）升至（４３±０３）ｍｍｏｌ／Ｌ，Ｐ＜００５〕均上升，硝苯地平组无变化；培哚普利组ＡＥＲ明显改善〔（８８±２２）降至（４４±３１）μｇ／ｍｉｎ，Ｐ＜０００１〕，另两组无变化。硝苯地平组副作用发生率最高。结论对老年高血压心肌肥厚患者，３种药均可有效降低血压。培哚普利减低ＬＶＭＩ并改善ＡＥＲ，卡托普利减低Ｌ?

Objective To compare the effecacy and acceptability of captopril(C), perindopril(P) and nifedipine(N) in the treatment of elderly hypertensive ventricular hypertrophy. Methods Ninety four patients were divided into 3 groups: C (n=30), P (n=32 ) and N (n=32); these drugs were given to the 3 groups respectively for 3 months with gradual increase of dosage after 2 weeks of placebo. Blood pressure (BP), echocardiogrophic left ventricular mass index (LVMI) and contractive function, urine albumine excretion rate (AER), plasma biochemical parameters were measured at baseline, before and each month after the drug administration. The drug side effects were recorded. Results After the drug administration, BP were reduced significantly in all the three groups with no difference among them, LVMI decreased in the C and P but not in N group. Plasma potassium levels(K+) increased in the C and P but not in N group. AER decreased in the P but not in the other groups. The incidence of side effects was highest in N group. Conclusions BP may be well controlled by each of the three drugs; P and C improved the regression of LVH and increased K+. P improved the renal function. There were no changes in LVMI, AER and K+ in the N group,but more side effects were found.