氯沙坦、苯那普利及二者联合治疗高血压病的对比性研究

Comparative Effects of Losartan versus Benazepril and Their Combination on Essential Hypertension

目的 对比氯沙坦、苯那普利及二者联合治疗轻、中度原发性高血压 (EH)的降压效果及耐受性。方法 入选的轻、中度EH患者 (坐位舒张压 90～ 10 9mmHg)经 1周药物冲洗期及 2周安慰剂期后 ,随机分为 3组 :(1)L组 ,口服氯沙坦 5 0mg/天 ;(2 )B组 ,口服苯那普利 10mg/天 ;(3)L +B组 ,口服氯沙坦 5 0mg/天 ,苯那普利 10mg/天。疗程 8周。共入选病例 6 7例 ,完成 8周观察者 6 3例 ,L组 2 2例 ,B组 2 0例 ,L +B组 2 1例。于服安慰剂期末及治疗 1、2、4、6、8周末测诊室血压、心率 (HR)并记录不良反应。治疗前后测血浆肾素活性 (PRA)、血管紧张素Ⅱ (AngⅡ )、醛固酮(ALD)浓度。结果 治疗 8周后三组血压均下降 ,其中L组下降 10 8± 6 .2 /17.5± 5 .5mmHg ,总有效率 5 9.1% ;B组下降 11.2± 5 .4 /16 .4± 4 .6mmHg ,总有效率 6 5 .0 % ;L +B组下降 2 6 .4± 5 .7/32 .1± 11.0mmHg ,总有效率 95 .2 %。L +B组降压幅度最大 ,与L组、B组比较有统计学意义 (P <0 0 0 1)。L组与B组的降压幅度及有效率无显著差异 (P >0 0 5 )。三组血浆ALD浓度在治疗后均下降 ,其中L +B组ALD下降较L组与B组显著 (P <0 0 0 1)。氯沙坦组不良反应少。结论 氯沙坦有明显降压作用 ,与苯那普利合用有叠加效应。

Objective To compare the efficacy and safety of losartan, benazepril and their combination in essential hypertensive patients. Methods All patients were selected from mild to moderate essential hypertension [sitting diastolic blood pressure(SiDBP)90～109 mmHg]. After 1 week washing out period and two weeks of placebo administration,the patients were divided into three groups: Losartan(50 mg/d) group;Benazepril(10 mg/d) group;losartan(50 mg/d)+Benazepril(10 mg/d) group. A total of 67 patients were enrolled in the study and only 63 patients completed 8 week trail (L group, 22 patients; B group, 20 patients; L+B group, 21 patients). At the end of placebo run in and 1,2,4,6,8 weeks after treatment, the result of clinic blood pressure, heart rate(HR) and adverse effects are recorded. Plasma renin activity(PRA), angiotensin(AngⅡ) and aldosterone(ALD) concentration were examined before and after the treatment. Results At the end of 8 weeks, SiSBP/SiDBP was decreased by 10 8±6.2/17.5±5.5 mmHg by losartan, 11.2±5.4/16.4±4.6 mmHg by benazepril and 26.4±5.7/32.1±11.0 mmHg by the combination therapy. The combination therapy group elicited a significantly greater reduction on blood pressure than losartan or benazepril monotherapy group ( P <0 001). No difference in the magnitude of BP reduction and response rate had been found between Losartan group and benazepril group ( P >0 05). Plasma ALD of three groups were reduced after treatment, especially in the combination group. Conclusions Losartan effectively lowered blood pressure, was generally well tolerated. Additive antihypertensive effects were obvious when Losartan and Benazepril were combined.