坎地沙坦联合卡维地洛治疗高血压合并左心室肥厚的临床观察

Clinical Observation of Candesartan Combined with Carvedilol in the Treatment of Hypertension Complicating with Left Ventricular Hypertrophy

目的:观察坎地沙坦联合卡维地洛治疗高血压合并左心室肥厚的临床效果。方法:选择我院2009年5月-2011年5月收治的80例高血压合并左心室肥厚的患者,其中对照组40例采用卡维地洛联合氨氯地平治疗(最初3d给予卡维地洛5mg,bid,若无异常反应,后增至10mg,bid;同时给予坎地沙坦8mg,qd,若血压未得到理想控制,可增至12mg,qd),观察组40例采用卡维地洛联合坎地沙坦治疗(卡维地洛的用法同观察组;同时给予苯磺酸氨氯地平5mg,qd,若血压未理想控制,可增至10mg,qd)。观察2组24h平均心率(HR)和24h平均收缩压(SBP)、舒张压(DBP)以及各项心脏结构指标,并观察2组不良反应。结果:与治疗前比较,2组HR和SBP、DBP均显著改善,差异有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05)。与治疗前比较,观察组舒张末期左心室后壁厚度(LVPWT)、舒张末期室间隔厚度(IVST)、左心室重量指数(LVMI)、舒张末期左心室内径(LVEDD)显著减小,差异均有统计学意义(P<0.05),且LVPWT和LVMI减小幅度显著大于对照组(P<0.05);而对照组各指标治疗前、后比较无显著性差异(P>0.05)。2组不良反应发生率无显著性差异(P>0.05)。结论:高血压合并左心室肥厚的患者采用坎地沙坦联合卡维地洛治疗有显著降压作用,能逆转左心室肥厚,并能有效保护高血压靶器官功能,且安全性较好。

OBJECTIVE： To observe the clinical efficacy of candesartan combined with carvedilol in the treatment of hyperten- sion complicating with left ventricular hypertrophy. METHODS： 80 hypertension patients with eft ventricular hypertrophy in our hospital during May 2009--May 2011 were analyzed retrospectively. 40 patients in control group were given carvedilol combined with amlodipine （carvedilol 5 mg, bid, on the first 3 days, under normal condition the dose of carvedilol increased to 10 mg, bid, later; candesartan 8 mg once a day, then increased to 12 mg if blood pressure control didn＇t produce best result）. 40 patients in ob- servation group were treated with carvedilol combined with candesartan （usage and dosage of carvedilol were same to control group, amlodipine besylate 5 mg once a day, then increased to 10 mg if blood pressure control didn＇t produce best result）. 24 h mean heart rate （HR）, 24 h mean diastolic blood pressure （DBP） and systolic blood pressure （SBP） and heart index were ob- served in 2 groups, and ADR was also observed. RESULTS： Compared with before treatment, HR, SBP and DBP of 2 groups were improved significantly, there was statistical significance （P〈0.05）, but there was no statistical significance between 2 groups （P〉0.05）. Compared with before treatment, LVPWT, IVST, LVMI and LVEDD were decreased significantly, there was statisti- cal significance （P〈0.05）, and the decrease of LVPWT and LVMI were more significant in observation group than in control group （P〈0.05） ; the detection indexes of control group had no significant difference before and after treatment （P〉0.05）. There was no significant difference in the incidence of ADR between 2 groups （P〉0.05）. CONCLUSION： Candesartan combined with carvedilol have significant antihypertensive effect on hypertension patients with left ventricular hypertrophy, can reverse left ventric- ular hypertrophy, and can effectively protect hypertensive target organ function with good safety.