氯沙坦对老年高血压患者室性心律失常的影响

Effect of Iosartan on ventricular arrhythmia in elderly patients with hypertension

目的 探讨氯沙坦对老年高血压患者室性心律失常的影响. 方法 65～89岁老年高血压合并室性心律失常患者78例随机分为氯沙坦治疗组及依那普利治疗组,疗程12个月.观察指标为血压、左室心肌质量指数及室性心律失常数. 结果治疗结束后两组的降压疗效相仿,差异无统计学意义（P＞0.05）.左室心肌质量指数依那普利组[（109.2±15.4）g·m-2]低于氯沙坦组[（128.5±16.7）g·m-2]（t=2.015,P＜0.05）.室性心律失常数氯沙坦组[（628.5±176.8）次/24h]低于依那普利组[（852.9±215.7）次/24 h]（t=2.417,P＜0.05）.相关性分析结果显示,氯沙坦治疗组室性心律失常减少与血压下降（收缩压r=0.094,P＞0.05;舒张压r=0.08,P＞0.05）及左室心肌质量指数降低（r=0.104,P＞0.05）不相关. 结论尽管具有相似的降压疗效,但氯沙坦对老年高血压患者室性心律失常的疗效优于依那普利.

Objective To evaluate the effect of losartan on ventricular arrhythmia in elderly patients with hypertension.Methods The 78 hypertension subjects with ventricular arrhythmia aged 65 to 89 years were randomly assigned to treatment with losartan or placebo （enalapril） for 12 months. The blood pressure, left ventricular mass index and ventricular arrhythmia were observed and analyzed.Results After 12 months treatment, the pressure lowering effect was similar in losartan versus enalapril groups, there were no differences in systolic pressure decrement and diastolic pressure decrement between the two groups （P〉0. 05）. Left ventricular mass index was lower in enalapril groupthaninlosartangroup [（109.2±15. 4） g · m-2 vs. （128.5±16. 7） g · m-2, t=2.015, P〈0. 05]. However, the prevalence of ventricular arrhythmia was lower in losartan group than in enalapril group [（628. 5±176.8）/24 h vs. （852.9±215.7）/24 h, t=2.417,P〈0.05]. No Pearson＇s correlations of reduction of ventricular arrhythmia with reduction of blood pressure （systolic： r=0. 094, P〉0. 05; diastolic： r= 0.08, P〉0. 05） and reduction of left ventricular mass index were found. in losartan group.Conclusions Initiation of antihypertensive treatment with losartan in elderly subjects appears to cause more reduction of ventricular arrhythmia than with enalapril, despite similar reduction of blood pressure.