坎地沙坦联合二甲双胍对肥胖型高血压患者的降压疗效与左心室重构及相关代谢指标的影响

Effects of Candesartan combined with Metformin on antihypertension and left ventricular remodeling and related metabolic index in obese patients with hypertension

目的 观察坎地沙坦联合二甲双胍对肥胖型高血压患者的降压疗效与左心室重构及相关代谢指标的影响.方法 纳入2016年7月至2017年7月成都医学院第一附属医院、成都总医院、广东省中医院和重庆市第三人民医院收治的400例肥胖型高血压患者(排除糖尿病)作为研究对象.根据受试者筛选入组顺序随机均分为观察组和对照组,两组均在基本干预基础上接受相应治疗24周.观察比较两组治疗前后白天、夜间、24 h平均收缩压(SBP)及舒张压(DBP),舒张期室间隔厚度(IVST)、舒张期左心室后壁厚度(LVPWT)、左心室舒张末内径(LVEDD)、左心室质量指数(LVMI),以及体重指数(BMI)、腰围、胰岛素抵抗指数(HOMA-IR)、腹内脂肪面积(VA)、腹部皮下脂肪面积(SA)及不良事件发生率.结果 两组治疗后24 h、白天、夜间平均SBP、DBP较治疗前均明显降低(P均<0.05),且观察组较对照组降低更为显著(P均<0.05).治疗24周后,与对照组相比,观察组在白天平均SBP[(130.42±7.81)mm Hg比(136.13±6.92)mm Hg]、夜间平均SBP[(125.70±7.32)mm Hg比(132.13±8.04)mm Hg]、白天平均DBP[(87.72±5.47)mm Hg比(92.82±6.38)mm Hg]、夜间平均DBP[(73.25±5.18)mm Hg比(77.40±7.65)mm Hg]方面降低更显著(P均<0.05).两组治疗后IVST、LVPWT、LVEDD及LVMI较治疗前均明显降低(P均<0.05),且观察组较对照组降低更为显著(P均<0.05).与对照组比较,观察组治疗24周后BMI、HOMA-IR、VA、SA水平均明显降低(P均<0.05).两组均无不良事件发生.结论 坎地沙坦联合二甲双胍对肥胖型高血压患者降压效果显著,可有效逆转左心室重构,并明显改善体脂分布,减轻胰岛素抵抗,值得临床广泛应用.

Objective To observe effects of Candesartan combined with Metformin on antihypertension and left ventricular remodeling and related metabolic index in obese patients with hypertension.Methods A total of 400obese hypertensive patients(excluding diabetes)admitted to the four hospital(the First Attiliated Hospital of Chengdu Medical College,Chengdu Military General Hospital,Guangdong Provincial Hospital of Traditional Chinese Medicine,Chongqing Third People's Hospital)from July 2016to July 2017were enrolled in the study. The patients were randomly divided into the control group and the observation group and both groups received corresponding treatment based on routine intervention for 24weeks.Levels of systolic blood pressure (SBP), diastolic blood pressure (DBP),the interventricular septal thickness (IVST),left ventricular posterior wall thickness (LVPWT),left ventricular end diastolic diameter (LVEDD),left ventricular mass index (LVMI),body mass index (BMI),waist circumference,homeostasis model assessment-insulin resistance index (HOMA-IR), visceral fat area(VA),subcutaneous fat area(SA)and incidence rate of adverse reactions after the treatment were observed and compared between two groups.Results The average SBP and DBP of 24hours after treatment were significant lower than those before treatment (P<0.05,respectively).After 24weeks of treatment,compared with the control group,the average SBP [(130.424-7.81)mm Hg vs.(136.134-6.92)mm Hg],night average SBP [(125.70±7.32)mm Hg vs.(132.13±8.04)mm Hg],day average DBP [(87.72±5.47)mm Hg vs.(92.82±6.38) mm Hg],night average DBP [(73.25±5.18)mm Hg vs.(77.40±7.65)mm Hg]in the observation group decreased more significantly (all P<0.05).The LVPWT,IVST,LVEDD and LVMI of two groups after treatment were significantly lower than those before treatment(P<0.05,respectively).Compared with the control group after 24- week treatment,there were obviously significant reductions in levels of BMI,HOMA-IR,VA and SA in the observation group(P<0.05,respectively).There were no adverse events in either group.Conclusion Candesartan combined with Metformin can practical reduce blood pressure level,effectively reverse left ventricular remodeling,improve body fat distribution and reduce insulin resistance in obese patients with hypertension.