氯沙坦对高血压伴心房纤颤患者脑卒中一级预防的效果研究

The primary prevention effect of losartan potassium on patients with hypertension and stroke

目的观察长期121服氯沙坦对高血压伴心房纤颤（房颤）患者脑卒中一级预防的效果。方法采用前瞻性随机对照研究方法，将180例高血压伴房颤患者随机分为观察组和对照组，每组90例，分别予以口服氯沙坦和美托洛尔治疗，治疗时间均为3年。观察血压、脉压变化以及脑卒中发生率和因心血管事件的病死率。结果治疗3年后，两组患者血压均显著下降（均P〈0．01）。但治疗组血压波动幅度、脉压均明显降低（均P〈0．01），而对照组无明显变化（P〉0．05）。观察组脑卒中发生率、心肌梗死发生率以及因心血管事件病死率分别为22．2％、10．0％和13．3％，与对照组的70．0％、40．0％和44．4％相比，差异均有统计学意义（均P〈0．01）。结论氯沙坦与美托洛尔比较，降压效果相同，但对脑卒中一级预防的效果明显优于美托洛尔。

Objective To study the effect of angiotensin II type 1 receptor antagonist（ARB） losartan on reducing the incidence of stroke in patients which suffer from hypertension and atrial fibrillation（AF）. Methods Pro- spective randomized analysis was used to divide one hundred and eighty hypertension patients with atrial fibrillation into two groups. ARB treatment group was treated with losartan（ n = 90） and beta-blockers treatment group was treated with metoprolol （ n = 90）, all patients were treated for three years and followed up. Blood pressure, pulse pressure, inci- dence of stroke and myocardial infarction and mortality of cardiovascular events were evaluated. Results After anti- hypertensive treatment,blood pressure was reduced in two groups, the pulse pressure in losartan group was reduced obviously（ all P 〈0. 01 ）. The incidence of stroke and myocardial infarction and mortality of cardiovascular events in losartan group were 22. 2%, 10. 0% and 13.3% ,respectively,lower than that in metoprolol group 70.0% ,40.0% and 44. 4% （ all P 〈 0. 01 ）. Conclusion Losartan reduced the incidence of stroke in the hypertension patients with AF.