非洛地平与赖诺普利的降压效应及对左室肥厚逆转作用的对比

Comparison of hypotensive effect and amelioration ofleft ventricular hypertrophy by felodipine and lisinopril

目的：评价并比较非洛地平及赖诺普利治疗轻、中度原发性高血压（ＥＨ）的降压疗效及对左心室肥厚的逆转作用。方法：选择１２８例轻、中度ＥＨ患者，入选前服用安慰剂２周，随机分为非洛地平组６６例和赖诺普利组６２例。非洛地平组服用非洛地平５～１０ｍｇ／ｄ，赖诺普利组服用赖诺普利１０～２０ｍｇ／ｄ，每日１次，疗程２４周。两组均在治疗前及治疗后的２、１２、２４周分别进行偶测血压、２４ｈ动态血压及超声心动图检查。结果：非洛地平和赖诺普利均能显著降低血压，两药对偶测血压的下降幅度差异无显著性（Ｐ＞０．０５）。非洛地平能有效控制清晨高峰期血压。收缩压、舒张压的谷／峰比值分别是７２％、６７％。非洛地平降低２４ｈ平均血压和白昼血压的幅度大于赖诺普利，而夜间血压降低的幅度显著低于白昼。两药治疗２４周后，室间隔厚度、左心室后壁厚度、左室心肌重量及左室重量指数较治疗前显著改善（Ｐ＜０．００１）。两组药物副反应均较轻。结论：非洛地平能有效降低ＥＨ患者的血压，降低靶器官损害的危险性。

Objective: To investigate the hypotensive effect and reverse reduction of left ventricular hypertrophy in felodipine treatment and compace with lisinopril. Method: 128 mild and moderate hypertensive patients (sitting diastolic blood pressure,DBP 95114 mmHg)were randomly divided into felodipine treatment group (66 cases) and lisinopril treatment group (62 cases).The daily dose of felodipine was 5 to 10 mg,and lisinopril was 10 mg to 20 mg,both drugs were given once daily.The treatment lasted for 24- weeks.Casual blood pressure (CBP) was assessment during the 2 weeks washout period on placebo and after 2,12,24 weeks of treatment.24hour amhulatory blood pressure monitoring (ABPM) was performed over a 24hour period at baseline and end of 12 weeks of treatment.Echocardiography was examined before and after 24 weeks of treatment. Result: No difference was found in the level of B.P. reduction between felodipine and lisinopril.CBP was significantly reduced by both drugs.The rapid rise in blood pressure in th e Lisinoprile morning hours was well controlled by felodipine,however,felodipine was better than lisinopril.The trough to peak ratios for systolic blood pressure and DBP were 22% and 67% respectively.Felodipine had greater reduction of 24hour mean and day mean ABPM than that of lisinopril.The reduction of night BP was significantly lower than that of day.After 24weeks treatment of both drugs interventricular septum thickness left ventricular posterior wall thickness,left ventricular mass and index of left ventricular mass were improved significantly (P<0.001).The side effects of both drug were mild. Conclusion: felodipine could effectively control the hypertension and protect the end organs in the most of the patients.