高血压患者的无症状性心肌缺血及培哚普利治疗的影响

Silent Myocardial Ischemia in Hypertensive Patients and Effect of Perindopril Treatment

目的:探讨原发性高血压患者的无症状性心肌缺血(SMI)发生率和发作规律,研究培哚普利降压治疗对SMI的影响。方法:172例高血压患者和34例健康人均作动态心电图,采用1×1×1规则判定SMI发作。选30例有SMI发作但无ACEI禁忌症的高血压患者,服培哚普利4mg qd半年,1月、2月、4月、6月末作动态心电图复查。结果:172例高血压患者中60例共出现101次SMI发作,发生率34.9%,健康对照组无SMI,两组有极显著的差异(p<0.001)。高血压患者的SMI发作以上午6:00至9:00最多,与其他时段比较有显著性差异(p<0.05)。培哚普利治疗后血压明显降低,1个月后与治疗前比较有显著性差异(p<0.05-0.01),治疗2个月后SMI发作次数初显减少(p<0.05),而SMI发作的明显变化包括例数、次数的明显减少(p<0.01),迟至4月后才出现。心肌缺血总负荷在治疗4月后与治疗前比较有非常显著的降低(25.43±5.81mm.min,58.28±14.52mm.min,p<0.01)。结论:高血压患者可出现SMI,培哚普利长期治疗有助于控制SMI发作。

Objective To study the incidence and the behavior during daily activities of silent myocardial ischemia（SMI）in hypertensive patients,and the effect of perindopril treatment.Methods Baseline holter monitoring was performed in 172 hypertensive patients and 34 healthy control and SMI was recognized based on 1×1×1 criteria of ST segment shift.Thirty patients without contraindications to ACE inhibitor were randomly selected from hypertensive patients with recognized SMI as follow-up group.Perindopril（4mg qd）were given for 6 months and holter monitoring was repeated by the end of 1,2,4,6 months after theatment.Results In contrasts to 0 SMI in control group,60 cases of the 172 hypertensive patients had SMI（0%,34.9%,p0.001）.The incidence of SMI was significantly higher in the period of 6am to 9am（p0.05）.In the perindopril group,a significant decline in blood pressure was observed after one month of perindopril treatment.An initial decreases of SMI was observed after 2 months treatment（p0.05）,although a very significant decrease of incidence of SMI was not observed until four months of perindopril treatment（p0.01）.Total ischemia bunder after 4months treatment was significantly less than the baseline（25.43±5.81,58.28±14.52,p0.01）.Conclusion SMI is a common phenomenon in hypertensive patients.Perindopril may decrease the incidence of SMI in long term use.