氯沙坦对高血压左室肥厚的影响

The Effect of Losartan on Hypertensive Left Ventricular Hypertrophy

目的 探讨氯沙坦对高血压左室肥厚 (LVH)的逆转及左室收缩和舒张功能的影响。方法 6 8例高血压LVH患者给予口服氯沙坦 (5 0～ 10 0 )mg/d、部分病例加用氢氯噻嗪 12 .5～ 2 5mg/d)共 2 0周。观测治疗前后心率(HR)、坐位收缩压 (SBp)、舒张压 (DBp)、超声心动图左房内径 (LAD)、舒张末期室间隔厚度 (IVST)、左室后壁厚度(PWT)、左室舒张末期内径 (LVDd)及左室短轴缩短率 (LVFS)、左室射血分数 (LVEF)、二尖瓣舒张早期和舒张晚期血流峰速度比 (E/A)及左室重量指数 (LVMI)的变化。结果 氯沙坦治疗 2 0周后 ,患者SBp、DBp明显下降 (P <0 .0 0 0 1) ;IVST、PWT、LAD、LVMI明显减小 (P <0 .0 0 1) ;LVDd有增大趋势 ,但差异不明显 (P >0 .0 5 ) ;心率及LVEF、LVFS无明显变化 (P >0 .0 5 ) ,而E/A明显上升 (P <0 .0 1)。结论 (1)氯沙坦可以显著降低高血压LVH患者的血压 ,逆转LVH ;(2 )氯沙坦可以明显改善左室舒张功能 ,但对心率及左室收缩功能无明显影响 ;(3)氯沙坦副作用小。

Objective To investigate the effects of Losartan on hypertensive left ventricular hypertrophy (LVH) and left ventricular systolic and diastolic functions.Methods Losartan (50-100 mg/day) and additional hydrochloro thiazide (12.5-25 mg/day),if necessary,were administered for 20 weeks to 58 essential hyprtensive LVH patients..The sitting systolic and diastolic blood pressure (SBp and DBp),M?mode and pulsed Doppler echocardiography and heart rate (HR) were performed before and after treatment,and the changes in various parameters,such as echocardigraphic left atrial dimension (LAD),the left ventricular end diastolic dimension (LVDd) and the thickness of interventricular septum(IVST) and posterior wall (PWY),the left ventricular percentage fractional shortening and the ejection factional,and the ratio of the peak early diastolic velocity(E) to the peak atrial systolic velocity(A) of transmitral flow(E/A),left ventricular mass index(LVMI) before and after treatment with Losartan were examined.Results In all of the 68 patients, SBp,DBp,LAD,IVST,PWT and LVMI decreased significantly after Losartan administration ( P <0.001 or P <0.0001);LVDd slightly increased but without significance ( P >0.05);HR,LVEF and LVFS showed no obvious changes ( P >0.05)the ratio E/A increased significantly ( P <0.01).Conclusion (1) Losartan has the effects on reduction of SBp and DBp, and on the regression of LVH.);(2) Losartan can improve left ventricular diastolic function,but has no effect on HR and left ventricular systolic function:(3) Losartan is well tolerated and has fewer adverse effects.