替米沙坦对高血压伴心功能不全患者阵发性心房颤动复发的影响

Effect of telmisartan on recurrence of paroxysmal atrial fibrillation in patients with hypertension and cardiac dysfunction

目的观察替米沙坦对高血压伴心功能不全患者阵发性心房颤动（简称房颤）复发的影响。方法将272例阵发性房颤患者分为单纯高血压病组（A组）82例、舒张期功能障碍组（B组）91例、收缩期功能障碍组（c组）99例，各组又随机分为观察组与对照组。所有患者均口服标准剂量和疗程的胺碘酮，观察组在此基础上口服替米沙坦，对照组禁用肾素-血管紧张素抑制剂。随访患者6个月，观察并比较血压、房颤复发情况及左室舒张末内径（LVEDD）、左房内径（LAD）的变化。结果治疗前、后观察组和对照组同亚组血压比较，差异均无统计学意义（P〉0．05）。治疗后6个月内，观察组B组、c组房颤复发患者比例和次数均低于对照组同亚组（P〈0．05），且c组更显著（P〈0．01），而治疗后3个月内观察组与对照组同亚组间及治疗后6个月内观察组和对照组A组房颤复发患者比例和次数比较，差异无统计学意义（P〉0．05）；观察组c组治疗后首次房颤复发时间明显长于对照组（P〈0．05），而A、B同亚组比较，差异均无统计学意义（P〉0．05）。治疗前，观察组和对照组同亚组间LVEDD、LAD比较，差异均无统计学意义（P〉0．05）。与治疗前比较，治疗后6个月末观察组C组LVEDD、LAD明显缩小（P〈0．01），但其余组患者的LVEDD、LAD无显著变化（P〉0．05）。结论替米沙坦能减少高血压伴心功能不全患者阵发性房颤的复发，可能与抑制心房结构重构有关。

Objective To observe the effect of telmisartan on recurrence of paroxysmal atrial fibrillation（AF） in patients with hypertension and cardiac dysfunction. Methods A total of 272 patients with paroxysmal AF were divided into the simple hypertension group （group A, 82 cases）, diastolic dysfunction group （group B,91 cases） and systolic dysfunction group （group C,99 cases）, then each group was randomly divided into observation group and control group. All patients received standard dose and period of amiodarone, and the observation group received telmisartan, whereas the control group was prohibitedthe use of renin-angiotensin system inhibitors. Changes of blood pressure （Bp） , recurrence of AF,left ventricular end-diastolic diameter （LVEDD）, and left atrial diameter （LAD） were observed during 6 months follow-up. Results There were no significant differences of Bp between the same subgroup of observation group and control group before and after treatment （ P 〉 0. 05 ）. Six months after treatment, proportion of patients and times of AF recurrence in group B and C of observation group were lower than those of the same subgroup in control group （ P 〈 0. 05 ） , and the difference in group C was more significant（P 〈 0.01 ）. There were no significant differences in proportion of patients and times of AF recurrence between the same subgroup 3 months after treatment and group A of observation group and control group 6 months after treatment （P 〉 0.05）. The first recurrence time of AF in group C of observation group was significantly longer than that of control group （ P 〈 0. 05 ） , hut it was not significantly different between group A and B （ P 〉 0.05 ）. There were no significant differences of LVEDD and LAD between the same subgroup of observation group and control group before treatment（ P 〉 0. 05 ）. At the end of 6 months after treatment,LVEDD and LAD in group C of observation group reduced significantly （P 〈 0.01 ）. But there were no significant changes of LVEDD and LAD in patients of other groups （ P 〉 0.05 ）. Conclusion Telmisartan can reduce recurrence of paroxysmal AF in patients with hypertension and cardiac dysfunction which may be via the inhibition of atrial structural remodeling.