两种不同血管紧张素ⅡⅠ型受体拮抗剂治疗轻中度原发性高血压的临床研究

Clinical Study on Treating Mild and Moderate Essential Hypertension with Two AT_1 Antagonists

目的:探讨缬沙坦和氯沙坦治疗轻中度原发性高血压的临床疗效及安全性。方法:117例轻中度原发性高血压患者随机分为两组,缬沙坦(治疗)组59例,80～160mg/d,口服,疗程半年;氯沙坦(对照)组58例,50～100mg/d,口服,疗程半年。治疗前后测偶测血压、动态血压、肝肾功能、血脂、血糖、血尿酸,血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)醛固酮(ALd)、内皮素(ET)等,并观察心脑事件发生情况。结果:治疗组总有效率74.6％(44/59例),降压幅度26.2/15.1mmHg,谷/峰(T/P)比值:收缩压(SBP)0.28、舒张压(DBP)0.78,与对照组总有效率74.1％(43/58例),降压幅度25.9/15.8mmHg,T/P比值:SBP 0.81、DBP 0.79均相似(P均>0.05)。两组治疗后PRA、AngⅡ均升高(P均<0.05);Ald、ET均降低(P均<0.05),但组间对照无显著性差异(P>0.05)。血尿酸也明显下降(P均<0.05),且基础值越高,降幅越大,对于治疗前高尿酸血症患者,对照组降压大于治疗组(P<0.05)。半年随访,两组心脑血管事件发生率相似(P>0.05),治疗组不良么应轻微。结论:缬沙坦是一种安全、作用持久、稳定、耐受性好、用药方便的治疗轻中度原发性高血压的新型AngⅡⅠ型受(AT1)拮抗药物之一,值得临床推广应用。

Objects: to explore the clinical effects and safety of treating mild and moderate essential hypertension with valsartan and losartan. Method: 177case were assigned into groups, one treated with valsartan 80 - 160mg, another with losartan once dily for half a year. Occassional blood pressure, ambulatory blood pressure, renal and hepatic function, plasma renin activity (PRA), plasma levels of angiotensinⅡ (AngⅡ), aldosterone and after the therapy. Cardiocerebral events were monitored. Result The total effective rate, amplirade of blood pressure reduced, T/P ratio of systolic and diastolic blood pressure in valsartan group were 74. 6% (44/59), 26. 2/15. 1mmHg, 0. 82 and 0. 78 respectively, and than of the losartan group, were74. 1(43/58), 25. 9 ± 15. 8mmHg, 0. 81 and 0. 79 respectively. PRA and Angll elevated after the therapy( P < 0. 05 - 0.01), while ET decreased (P < 0. 05) in both groups, there were no significant differences between two groups (P > 0. 05) . Uric acid level of blood also reduced after the treatment, and the higher the level before the patients with hyper-uroacidemia in losartan group( P <0. 05). The cardiocerebral events of two groups were similar half a year's therapy. Adverse reactions in valsartan group were mild. Conclusion: Valsartan is a new ATI antagonist, it is safety , and with a long and steady antihypertensive effect, also shows a good tolerant profile. It worhtes recommending in clinical practice.