氨氯地平加替米沙坦或复方阿米洛利联合治疗对原发性高血压左心室肥厚患者校正的Q-T离散度的影响

Effects of amlodipine combined with telmisartan or with amiloride on QT dispersion in hypertensive patients with left ventricular hypertrophy

目的探讨不同联合降压治疗对原发性高血压左心室肥厚(LVH)患者校正的Q-T离散度(QTcd)的影响。方法入选原发性高血压患者111例,包括单纯高血压患者60例(男34例,女26例),年龄(60.7±5.6)岁,及原发性高血压LVH患者51例(男28例,女23例),年龄(61.8±7.0)岁。原发性高血压LVH患者随机分为低剂量氨氯地平(2.5mg/d)加替米沙坦(40mg/d)组(n=26)和氨氯地平(2.5mg/d)加复方阿米洛利(半片/d)组(n=25),治疗1年。于治疗前后分别行心动超声检查,检测左心室质量指数(LVMI)等指标、测量QT间期(QT)、校正的QT间期(QTc)及QTcd等,并进行比较分析。血压正常者56名(男31名,女25名)作为对照组,年龄(59.3±6.7)岁。结果高血压LVH组、单纯高血压组及对照组一般临床特征相似。高血压LVH患者QTcd[(34±10)ms]较对照组和单纯高血压患者明显延长(均P<0.05)。氨氯地平加替米沙坦组和氨氯地平加复方阿米洛利组患者基线血压、QT、QTc、QTcd、LVMI、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室舒张末期内径(LVIDd)等临床指标差异无统计学意义(均P>0.05)。与治疗前比较发现,降压治疗1年后氨氯地平加替米沙坦和氨氯地平加复方阿米洛利联合治疗均能有效控制血压(均P<0.05),降低LVMI、IVST和LVPWT(均P<0.05),同时QTc、QTcd亦缩短(均P<0.05)。氨氯地平加替米沙坦组在降压及降低LVMI、IVST等方面优于氨氯地平加复方阿米洛利组(均P<0.05),且QTcd较氨氯地平加复方阿米洛利组明显缩短(P<0.01)。结论氨氯地平联合替米沙坦在有效控制血压,逆转LVH,改善心室厚度均匀性的同时,可明显改善心室肌复极同步性,其效果优于氨氯地平联合阿米洛利治疗。

Objective To investigate the effects of amlodipine combined with telmisartan or with amiloride on corrected QT dispersion（QTcd）in hypertensive patients with left ventricular hypertrophy（LVH）.Methods Sixty primary hypertensive patients[male 34,female 26,average age（60.7±5.6）years]were enrolled as hypertensive group.Fifty-one primary hypertensive patients with LVH [male 28,female 23,average age（61.8±7.0）years] were randomly assigned to receive low-dose amlodipine（2.5mg/d）plus telmisartan（40mg/d）or low-dose amlodipine（2.5mg/d）plus compound amiloride（0.5tablet/d）.All the patients were followed up for 1year.Upon enrollment and one year later left ventricular mass index（LVMI）,QT,QTc and QTcd were measured.Fifty-six nomotensive individuals served as control [male 31,female 25,average age（59.3±6.7）years].Results Patient＇s conditions at enrollment were similar among hypertensive LVH,hypertensive and nomotensive groups.The values of QTcd in hypertensive LVH patients[（34±10）ms]were significantly higher than those in control（all P0.05）.There were no significant differences in baseline blood pressure,LVMI,QTc and QTcd between amlodipine with telmisartan and amlodipine with amiloride groups.After 1year treatment,blood pressure was reducedsignificantly in both amlodipine with telmisartan and amlodipine with amiloride groups（both P0.05）.Interventricular septal thickness（IVST）,LVMI and QTcd decreased significantly compared to baseline values（all P0.05）.The amlodipine with telmisartan had higher efficacy than amlodipine with amiloride group in reducing blood pressure,LVMI,IVST and left ventricular end diastolic diameter（LVPWT）（all P0.05）,especially QTcd[（30±7）vs（34±7）ms,P0.05].Conclusion The combination of amlodipine and telmisartan was superior to amlodipine with amiloride group in controling blood pressure,attenuating LVH and improveing the heterogeneity ventricular repolarization.