贝那普利联合美托洛尔治疗老年原发性高血压合并心力衰竭疗效观察

Effect of benazepril combined with metoprolol on essential hypertension complicated with heart failure

目的探讨老年原发性高血压合并心力衰竭患者应用贝那普利联合美托洛尔治疗的效果。方法老年原发性高血压合并心力衰竭患者90例,随机分为贝那普利组、美托洛尔组和联合组各30例。贝那普利组给予盐酸贝那普利片10mg/次,1次/d,口服;美托洛尔组给予酒石酸美托洛尔片50 mg/次,1次/d,口服;联合组给予盐酸贝那普利片10mg/次,酒石酸美托洛尔片50mg/次,均1次/d,口服;3组均连续治疗6个月。分别于治疗前及疗程结束测定3组心率、收缩压、舒张压、左室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)、左心室收缩末期内径(left ventricular end-systolic dimension,LVESD)及6min步行试验结果,并进行比较。结果联合组治疗总有效率(96.67%)高于贝那普利组(76.67%)和美托洛尔组(73.33%)(P<0.05);贝那普利组、美托洛尔组和联合组治疗后心率、收缩压、舒张压水平均低于同组治疗前(P<0.05),联合组治疗后心率、收缩压、舒张压水平均明显低于贝那普利组和美托洛尔组(P<0.05);贝那普利组、美托洛尔组和联合组治疗后LVEF水平[(40.99±4.50)%、(41.30±4.55)%、(51.40±5.17)%]均高于同组治疗前[(34.33±3.85)%、(34.45±3.64)%、(34.42±3.61)%](P<0.05),LVEDD[(53.44±5.02)、(52.35±5.17)、(40.36±4.02)mm]、LVESD[(46.22±5.01)、(45.37±5.06)、(38.51±4.26)mm]水平均低于同组治疗前[LVEDD(61.46±5.80)、(61.50±5.77)、(61.44±5.82)mm,LVESD(54.02±4.77)、(53.99±4.79)、(53.97±4.85)mm](P<0.05),且联合组治疗后LVEF、LVEDD、LVESD水平与贝那普利组和美托洛尔组比较差异有统计学意义(P<0.05);贝那普利组、美托洛尔组和联合组治疗后6min步行试验水平[(455.98±22.98)、(446.47±24.02)、(566.79±25.47)m]均高于同组治疗前[(319.86±23.08)、(318.97±22.69)、(318.64±22.47)m](P<0.05),且联合组治疗后6min步行试验水平高于贝那普利组和美托洛尔组(P<0.05);贝那普利组与美托洛尔组治疗总有效率,以及治疗后心率、收缩压、舒张压、LVEF、LVEDD、LVESD、6min步行试验水平比较差异均无统计学意义(P>0.05)。结论贝那普利联合美托洛尔可改善老年原发性高血压合并心力衰竭患者心率、血压、心功能和6min步行试验,临床疗效满意。

Objective To explore the influence of benazepril combined with metoprolol on essential hypertension complicated with heart failure. Methods Ninety patients with essential hypertension complicated with heart failure were randomly divided into benazepril group, metoprolol group and combined group, with 30 patients in each group. Benazepril group received oral administration of 10 mg benazepril once a day, metoprolol group received oral administration of 50 mg metoprolol once a day, and combination group received oral administration of 10 mg henazepril and 50 mg metoprolol once a day, totally for 6 months. The heart rate, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, left ventricular ejection fraction （LVEF）, left ventricular end-diastolic dimension （LVEDD）, left ventrieular end-systolic dimension （LVESD） and 6 min walking test （6MWT） were detected before and after treatment, and compared among groups. Results The total effective rate was significantly higher in combination group （96.67 %） than that in benazepril group （76.67%） and metoprolol group （73.33%） （P〈0.05）. The levels of heart rate, SBP and DBP were significantly lower after treatment than those before treatment in three groups （P〈0.05）, and were significantly lower in combination group than those in benazepril group and metoprolol group （P〈0.05）. The levels of LVEF were significantly higher after treatment （ （40.99±4.50） %, （41.30 ± 4.55）%, （51.40 ± 5.17）%） than those before treatment （ （34.33 ± 3.85） %, （34. 45±3. 64）% , （34. 42±3. 61）%） （P〈0.05）, and the levels of LVEDD （（53. 44±5. 02）, （52. 35±5. 17）,（40.36±4.02） mm） and LVESD （（46.22±5.01）, （45.37±5.06）, （38.51±4.26） mm） were significantly lower after treatment than those before treatment （LVEDD： （61. 46 ± 5. 80）, （61. 50 ± 5. 77）, （61. 44 ± 5. 82） mm; LVESD： （54.02±4.77）, （53.99±4. 79）, （53. 97±4. 85） ram） in benazepril group, metoprolol group and combination group （P〈0.05）. The levels of LVEF, LVEDD and LVESD were significantly di[{erent in combination group from those in the other two groups after treatment （P〈0.05）. The 6MWTvalues after treatment （（455.98±22.98）, （446.47±24.02）, （566. 79±25. 47） m） were significantly higher than those before treatment （（319. 86±23.08）, （318. 97±22. 69）, （318.64±22.47） m） in benazepriI group, metoprolol group and combination group （P〈0.05）, and were significantly higher in combination group than those in benazepriI group and metoproIoI group （P〈0.05）. There were no significant differences in the total effective rate, SBP, DBP, LVEF, LVEDD, LVESD and 6MWT after treatment between benazepril group and metoprolol group （P〈 0.05）. COlldUsion Benazepril combined with metoprolol can improve the heart rate, blood pressure, cardiac function and 6MWT in patients with essential hypertension complicated with heart failure, with distinct curative effect.