地尔硫[艹卓]联合厄贝沙坦对原发性高血压患者左室重构及心肌缺血的影响

Effects of diltiazem combined with irbesartan on left ventricular remodeling and myocardial ischemia in patients with essential hypertension

目的:观察地尔硫联合厄贝沙坦对原发性高血压患者左室重构、心肌缺血的影响。方法:80例原发性高血压患者根据受试者筛选入组顺序随机分为2组,其中对照组40例,每日口服厄贝沙坦片150mg,1次/d,观察组40例,每日口服厄贝沙坦片150mg,1次/d,地尔硫片30mg,3次/d,两组疗程均为24周。比较两组治疗前后白天、夜间、24h平均收缩压(SBP)及舒张压(DBP),比较两组治疗前后不同导联和不同时间段心肌缺血总负荷(TIB)变化,比较两组治疗前后舒张期室间隔厚度(IVST)、舒张期左室后壁厚度(LVPWT)、左室舒张末内径(LVDd)、左室质量指数(LVMI)等指标。结果:两组治疗后24h、白天、夜间平均SBP、DBP较治疗前均明显降低(P<0.05),且观察组治疗后较对照组治疗后降低更为显著(P<0.05),对照组治疗前后心率无显著性改变(P>0.05),观察组治疗后较治疗前和对照组治疗后明显降低(P<0.05);观察组治疗后MV5、MV1、AVF导联TIB及总TIB较治疗前和对照组治疗后均明显降低(P<0.05),而对照组治疗前后比较无显著性差异(P>0.05);观察组治疗后不同时间段TIB较治疗前和对照组治疗后均明显降低(P<0.05),而对照组治疗前后比较无显著性差异(P>0.05);两组治疗后IVST、LVPWT、LVDd及LVMI较治疗前均明显降低(P<0.05),且观察组较对照组降低更为显著(P<0.05);两组治疗期间药物不良反应发生率比较无显著差异性(P>0.05)。结论:地尔硫联合厄贝沙坦可有效逆转原发性高血压患者的左室重构,并明显改善心肌缺血的影响,降压效果显著,且不会明显增加药物不良反应,值得临床广泛应用。

Objective：To observe the effect of diltiazem combined with irbesartan on left ventricular remodeling and myocardial ischemia in patients with essential hypertension.Method：The 80 patients with primary hypertension were randomly divided into 2 groups.The control group（n=40）was treated with Irbesartan Tablets 150 mg by oral,qd and the observation group（n=40）was treated with Irbesartan Tablets 150 mg by oral,qd,plus diltiazem tablets 30 mg,tid.Then the two groups were treated for 24 weeks.The systolic blood pressure（SBP）,diastolic blood pressure（DBP）,total ischemia burden（TIB）were detected.The interventricular septal thickness（IVST）,left ventricular posterior wall thickness（LVPWT）,left ventricular end diastolic diameter（LVDd）,left ventricular mass index（LVMI）before and after treatment of two groups were compared.Result：The average SBP and DBP of24 hafter treatment,were significantly lower than those of before treatment（P〈0.05）.There was no significant change about heart rate in the control group before and after treatment（P〉0.05）.The TIB of MV5,MV1,AVF lead and total TIB of observation group after treatment decreased more significantly than those of before treatment.The TIB at different time of observation group after treatment decreased more significantly than those of before treatment.The LVPWT,IVST LVDd and LVMI of two groups after treatment were significantly lower than those of before treatment（P〈0.05）.Conclusion：The treatment of diltiazem combined with irbesartan can effectively reverse left ventricular remodeling in patients with essential hypertension.