氯沙坦和氢氯噻嗪逆转高血压患者左心室肥厚的机制及疗效观察

Clinical efficiency and action mechanism of losartan and hydrochlorothiazide in inversing left ventricular hypertrophy in patients with essential hypertension

目的观察氯沙坦和氢氯噻嗪对高血管紧张素-醛固酮的轻中度高血压患者的降压效果及其逆转左心室肥厚(LVH)的疗效和机制。方法我院2006年1月至2008年1月门诊和住院的高血管紧张素-醛固酮的轻中度高血压患者136例,随机分成2组。治疗组72例,氯沙坦和氢氯噻嗪治疗2年;对照组64例,苯磺酸氨氯地平治疗1年,比较2组药物的降压效果和逆转LVH的疗效,比较2组药物之间血浆血管紧张素Ⅱ(AngⅡ)和醛固酮(Ald)水平治疗前后的变化,并以超声心动图评定用药后LVH改善情况。结果治疗组降血压疗效优于对照组,能够更好降低患者血压,差异有统计学意义(P<0.05)。治疗组治疗后血浆AngⅡ和Ald水平明显下降(P<0.01),对照组AngⅡ和Ald水平有所下降(P<0.05),2组治疗后AngⅡ和Ald差异有统计学意义(P<0.01)。治疗组能有效逆转高血压LVH(P<0.01)。结论氯沙坦和氢氯噻嗪长期治疗可以安全有效降压,能够有效逆转LVH,氯沙坦和氢氯噻嗪逆转LVH的机制可能与其降低血浆AngⅡ和Ald水平有关,同时能够改善心肌舒张功能,对于高血管紧张素-醛固酮的高血压患者值得临床推广应用。

Objective To observe the clinical efficiency and action mechanism of losartan and hydrochlorothiazide in inversing left ventricular hypertrophy （LVH） in patients with moderate or middle degree essential hypertension and with high levels of angiotensin-aldosterone. Methods 136 patients with moderate or middle degree essential hypertension and with high levels of angiotensin-aldosterone including outpatients and inpatients in our hospital from January 2007 to December 2010 were randomly divided into two groups,the 72 patients in observation group were treated by losartan and hydrochlorothiazide for 2 years, and the other 64 patients in contrast group were treated by amlodipine besylate for 1 year. The effect of pressure release and the efficiency of inversing LVH were compared between the two groups, and the changes of levels of plasma Angiotensin Ⅱ （AngⅡ） and aldosterone （Aid） before and after treatment,furthermore, the echocardiogram was used to evaluate the improvement state after administration. Results The effect of pressure release in observation group was superior to that in control group, there was a significant difference between the two groups （ P 〈 0.05 ）. After administration the levels of AngⅡand Aid were significantly decreased,as compared with those before administration （ P 〈0.01 ） ,however,the levels of AngⅡ and Ald in control group were significantly decreased （ P 〈 0.05）, there were significant differences in the levels of AngU and Aid after treatment between two groups （ P 〈 0.01 ）. There was a significant difference in the effect of inversing hypertension LVH between observation group and control group （ P 〈 0.01 ）. Conclusion The long-term administration of losartan and hydrochlorothiazide in effective and safe in decreasing blood pressure,which can effectively inverse LVH, and its action mechanism may be correlated with its effect of decreasing the levels of plasma AngⅡ and Aid, meanwhile, which can improve myocardial diastolic function, so the treatment protocol is worthv of being Donularized for treating the patients with high levels of angiotensin-aldosterone.