缬沙坦长期治疗对原发性高血压患者左心室肥厚及心功能影响的对比研究

Effects of Valsartan on Left Ventricular Hypertrophy and Cardiac Functions in Patients With Essential Hypertension

目的 :探讨血管紧张素Ⅱ受体拮抗剂———缬沙坦对原发性高血压患者左心室肥厚及心功能的影响。 方法 :入选经超声心动图检查证实为原发性高血压的左心室肥厚患者 72例 ,随机分配到缬沙坦组 (口服 80～ 160mg/d)或阿替洛尔组 (口服 2 5～ 5 0mg/d) (n均 =3 6) ,治疗 8个月 ,治疗前后各检查一次超声心动图及放射性核素心室显像 ,对比分析组内治疗前后左心室重量指数及左心功能参数变化和两组间的差异。 结果 :①与治疗前比较 ,原发性高血压患者在缬沙坦或阿替洛尔治疗 8个月后 ,两组收缩压与舒张压明显下降(15 9/10 1mmHg至 14 2 /89mmHg ;161/10 3mmHg至 14 5 /90mmHg ,1mmHg =0 13 3kPa) (P均 <0 0 1)。②原发性高血压患者在缬沙坦治疗 8个月后 ,左心室后壁与室间隔厚度较治疗前显著下降 (P均 <0 0 5 ) ,左心室重量及左心室重量指数下降更显著 (P均 <0 0 1) ;而在阿替洛尔治疗 8个月后左心室后壁与室间隔厚度无明显变化 ,左心室重量及左心室重量指数下降显著 (P <0 0 5 )。③原发性高血压患者在缬沙坦治疗 8个月后左心室高峰充盈率明显增加 (P <0 0 5 ) ,而在阿替洛尔治疗 8个月后左心室高峰充盈率无明显变化 ,两组间比较则有明显差别 (P <0 0 5 )。 结论

Objective:To explore the effects of angiotensin Ⅱ antagonist valsartan on left ventricular hypertrophy(LVH) and cardiac functions in patients with hypertension. Methods: Seventy-two patients with essential hypertension and LVH revealed by echocardiography entered the study. Patients were randomized into the valsartan (80-160 mg/d) group or atenolol (25-50 mg/d) group,and treated for 8 months. Echocardiography and radionuclide ventriculography before and 8 months after treatment were conducted. Results: Eight months after treatment with valsartan or atenolol, blood pressure was reduced from 159/101 to 142/89 mmHg(p<0.01) or from 161/103 to 145/90 mmHg (p<0.01), respectively. Left ventricular mass index decreased from (164.98±60.33) g/m 2 to(128.13±34.15) g/m 2(p<0.01) or from (163.07±58.35) g/m 2 to (139.27±37.26) g/m 2 (p<0.05),respectively. Left ventricular peak filling rate increased from 1.87 to 2.59 (p<0.05) in valsatan group but not changed in atenolol group. Conclusion: Long-term treatment with valsartan resulted in a significant reduction of LVH and a significant amelioration of left ventricular diastolic function in patients with essential hypertension.