声学定量技术对ARB与ACEI在高血压病治疗中单用与联用优势的评价

Angiotensin receptor blockers and angiotensin converting enzyme inhibitors in treatment of essential hypertension:an evaluation of advantages of single use vs.combined use by acoustics quantity technology

目的应用超声心动图声学定量技术评价血管紧张素Ⅱ受体拮抗剂(ARB)与血管紧张素Ⅱ转换酶抑制剂(ACEI)在原发性高血压病治疗中单独用药与联合用药的疗效。方法随机选择150例1～3级原发性高血压病患者分为ARB组、ACEI组及ARB-ACEI联合用药组,每组50例,ARB组应用缬沙坦80mg/d、ACEI组应用雅施达4mg/d、ARB-ACEI联合用药组应用缬沙坦80mg/d及雅施达4mg/d口服治疗,3组疗程均为12个月。观察治疗前、治疗后患者血压及症状体征的变化情况、声学定量技术评价心脏形态学、室壁运动状态及心脏整体功能变化情况。结果 (1)3组用药方式均在治疗2w后血压开始下降,5w后趋于平稳。(2)3组受检者的心脏形态学参数在治疗12个月后均明显降低(P<0.01)并趋于稳定,左室壁运动状态及心脏整体功能均随之明显改善(P<0.01)。(3)3组用药方式降压作用均较为明显,但联合用药作用稍优于单独用药(P<0.05),ACEI组在逆转左室重构的疗效较ARB稍优(P<0.05)。结论 (1)ARB及ACEI均能有效逆转原发性高血压病所导致的左室重构,明显改善心脏整体功能,1级及2级高血压可视情况选用单药治疗,而3级高血压可采用联合用药治疗。(2)声学定量技术能够全面、客观地评价心脏结构、室壁运动状态及心脏整体功能情况。

Objective To assess the therapeutic effects of single use and combined use of angiotensin receptor blocker （ARB） and angiotensin converting enzyme inhibitor（ACEI） on essential hypertension by acoustics quantity technology.Methods 150 cases of grade 1-3 essential hypertension were randomly divided into three groups（ns=50）：single ARB treatment group（ARB group）,single ACEI treatment group（ACEI group） and ARB combined with ACEI treatment group（ARB-ACEI group）.ARB group took valsartan of 80 mg/d,ACEI group took perindopril of 4 mg/d and ARB-ACEI group took above two drugs at the same dosage for 12 months.Before and after 12 months of treatment,the blood pressure,symptoms and physical signs of all subjects were observed.The changes of cardinal morphology,wall motion and heart allomeric function were measured by acoustics quantity technology.Results （1） The blood pressure of subjects in three groups decreased gradually after 2 w of treatment,and it appeared a steady tendency after 5 w.（2）The parameters of the cardiac morphology in three groups decreased obviously and became steady after 12 months of treatment （P〈0.01）,and left ventricular wall motion as well as heart allomeric function were improved （ P〈0.01 ）.（3）All of three therapeutic regimens had remarkable antihypertensive effects,but the combined treatment showed a little better effect than either single drug treatment （P〈0.05 ）.ACEI group were better in reversing left ventricular remodeling than ARB group （P〈0.05）.Conclusion （1）Both ARB and ACEI can reverse left ventricular remodeling and improve heart allomeric function effectively.Single ARB or ACEI can be used to treat the patients with grade 1-2 essential hypertension according to their conditions,but those with grade 3 essential hypertension should be treated with the combination of ARB and ACEI.（2）Acoustics quantity technology can evaluate cardiac structures,wall motion and heart allomeric function overall and objectively in patients with essential hypertension.