伊贝沙坦对轻中度原发性高血压左室肥厚的逆转作用

 目的 观察伊贝沙坦对轻中度原发性高血压左室肥厚的逆转作用.方法 采用自身对照试验,对83例轻中度原发性高血压左室肥厚的患者,服用伊贝沙坦150 mg/d治疗,如4周无效加至300 mg/d,共12周,随访患者血压、超声心动图变化以及服药耐受性.结果 12周后,所有患者血压均较入院时明显下降(P<0.05),室间隔厚度(IVST)、心室后壁厚度(PWT)、左室重指数(LVMI)均有明显减少(均为P<0.01),说明左室肥厚减轻,左室舒张功能得到改善,且无明显不良反应.结论 伊贝沙坦是一个安全、有效的降压药物,同时能逆转左室肥厚.     

卡维地洛和科素亚对高血压左室肥厚和QT离散度的影响

 目的观察卡维地洛联合科素亚对高血压病(EH)左室肥厚和QT离散度(QTd)的影响.方法84例患者随机分为L、B两组,L组口服科素亚50mg/d;B组科素亚50mg/d合用卡维地洛20mg/d.治疗前及治疗后6个月分别进行标准12导联心电图和心脏超声检查,测量QT间期及有关心血管参数.结果L组治疗后左心室重量指数(LVMI)减低(P＜0.05)、QTd缩短(P＜0.05);B组治疗后LVMI减低(P＜0.01)、QTd缩短(P＜0.01),两组间比较LVMI和QTd差异有显著性意义(P＜0.05);治疗前后QTd与LVMI呈正相关(r＝0.62,P＜0.05).结论科素亚和卡维地洛合用,有协同逆转左室肥厚并能显著降低QTd.     

血管紧张素Ⅱ受体拮抗剂对原发性高血压左室肥厚68例影响

原发性高血压合并左室肥厚 (ＬＶＨ)时 ,猝死的发生率高于不伴ＬＶＨ时的 6倍[1] ,因此 ,能否逆转ＬＶＨ是衡量降压药是否理想的重要指标。ＡＣＥＩ能够逆转左室肥厚 ,降低猝死的发生率 ,在国内外已有较多报告。选择性血管紧张素Ⅱ受体— 1 (ＡＴ1)拮抗剂科素亚 (Ｃｏｚａａｒ)是 1种新型抗高血压药物 ,本文　旨在探讨Ｃｏｚａａｒ对左室肥厚的影响。1　资料和方法1 1　临床资料　选择 1 998年 2月～ 1 999年 1月来我院就诊的原发性高血压病人 68例 ,舒张压 (ＤＢＰ)在 90～ 1 1 5ｍｍＨｇ之间 ,收缩压 (ＳＢＰ)在 1 4 5～ 1 90ｍｍＨｇ之…     

卡维地洛联合科素亚对高血压患者左室结构及功能的影响

 目的观察卡维地洛联合科素亚对高血压病(EH)患者左室结构及功能的影响.方法观察84例高血压患者口服卡维地洛联合科素亚平均12个月后左室结构和功能改变.治疗前及治疗后12个月分别进行心脏超声检查,测量有关心血管参数.结果治疗后降压效果显著(P＜0.01),室间隔(IVST)、左室后壁(PWT)及左室重量指数(LVMI)均明显下降(P＜0.01),A峰速度明显下降,E峰速度及E/A比值明显增高(P＜0.01).结论卡维地洛联合科素亚治疗高血压病可安全有效降压,并同时逆转左室肥厚,改善左室舒张功能.     

科素亚对原发性高血压患者胰岛素抵抗的影响

观察科素亚对原发性高血压患者胰岛素抵抗的影响。按世界卫生组织诊断标准,选择原发性高血压患者40例,并与30例健康体检者相对照,原发性高血压患者服科素亚50mg,1次/d,共4周。对照组、原发性高血压组治疗前后均测定空腹静脉血糖、胰岛素及C肽,计算出胰岛素敏感指数。结果显示:原发性高血压组存在胰岛素抵抗,服科素亚4周胰岛素抵抗即有明显改善。     

硝苯地平与卡托普利对高血压左室肥厚的逆转作用比较

高血压病的左室肥厚[LVH]是冠心病的诸多危险因素之一，因此，防止和减轻LVH是改善冠心病预后的重要措施之一。国内外一些学者报道钙拮抗剂及血管紧张素转换酶抑制剂均有逆转左室肥厚和改善左室功能的作用。我们选择两类的代表药硝苯地平和卡托普利对比观察对高血压病人LVH的逆转作用。现将结果报告如下。对象和方法一、对象观察对象为64例住院高血压病人。诊断依据WHO标准。以往均未长期服用过钙抬抗药或血管紧张素转换酶抑制药。随机分为两组：硝苯地平组[I组]32例，男20例，女12例，年龄58土8岁，病程15土6年；卡托普利组[！组]32…     

科素亚与恬尔心治疗原发性高血压病的疗效

目的：评价科素亚与恬尔心对原发性高血压病人的降压效果,观察对尿酸的影响及不良反应。方法：选取轻、重度高血压病人80例,随机分为两组每组各40例。分别测定科素亚组及恬尔心组治疗前后的收缩压／舒张压,及血尿酸。结果：科素亚组和恬尔心组治疗前后的收缩压／舒张压,无明显差异（P〉0.05）,科素亚组有明显的降低血尿的效果（P〈0.01）;恬尔心至干咳发生率较高。结论：科素亚与恬尔心降压效果相近,但科素亚的不良反应比恬尔心少,并且科素亚有降低血尿酸的作用。     

吲哚帕胺对原发性高血压的降压作用及对左心室肥厚的逆转研究

研究吲哚帕胺(Indapamide)对原发性高血压的降压作用及对左心室肥厚逆转的影响。将75例伴有左心室肥厚的原发性高血压病人,随机分为吲哚帕胺治疗组(38例)和复方降压常规治疗对照组(37例)。分别在治疗2、4、6个月测量血压,并观察心脏体积。结果,治疗组与对照组比较,血压下降,无显著性差异(P>0.05)。而左心室肥厚逆转有显著性差异(P<0.05),对该病预后有重要临床意义。     

老年高血压伴左室肥厚与动态血压参数相关性分析

目的 观察老年高血压伴左室肥厚(hypertension with left ventricular hypertrophy,HLVH)患者24 h动态血压波动的特点,制定相关治疗措施.方法 76例老年高血压患者根据心脏多普勒超声结果分为高血压伴左室肥厚组(HLVH)35例、单纯高血压组(NHLVH)41例,采用动态血...     

老年高血压左心室肥厚及室性心律失常256例分析

由高血压引起的左心室肥厚临床上较常见,严重心律失常亦是老年高血压左心室肥厚患者猝死的原因之一。1997年1月-2001年12月,我们对我院老年高血压左心室肥厚与心律失常256例的临床资料进行了回顾性分析。现报告如下。     

氯沙坦和尼群地平治疗老年高血压病对左室肥厚的影响

 目的观察氯沙坦和尼群地平治疗老年高血压病对左室肥厚的影响.方法对132例老年高血压病伴左室肥厚住院患者随机分为氯沙坦组和尼群地平组治疗,随访1年,于治疗前及治疗后12个月分别测定患者血压、心率、左室舒张末内径(LVDd)、舒张期室间隔厚度(ⅣST)、左室后壁厚度(LVPWT)、左室射血分数(LVEF).结果治疗后,两组血压、LVDd、ⅣST、LVPWT、左室重量(LVM)、左室重量指数(LVMI)较治疗前均明显下降(P＜0.01);治疗后LVDd、ⅣST、LVPWT、LVM、LVMI,两组有显著性差异(P＜0.05或P＜0.01).结论尼群地平和氯沙坦均能有效控制血压、减轻左室肥厚,但氯沙坦比尼群地平逆转左室肥厚效果更好.     

高血压家族史对原发性高血压左室形态的影响

 目的 利用超声心动图技术检测有家族史与无家族史高血压患者左室形态变化,为高血压的临床防治和早期诊断提供依据.方法 对92例有家族史高血压患者和97例无家族史高血压患者应用超声心动图测定左室舒张末期内径(LVIDd)、室间隔厚度(IVST)及左室后壁厚度(LPWT),并计算左室重量指数(LVMI)及相对室壁厚度(RWT).结果 有家族史的高血压患者LVIDd、IVST、LPWT、LVMI普遍比无家族史患者大.结论 家族史对左室形态具有一定影响,在向心性肥厚型和离心性肥厚型中表现较明显.     

高血压病左室肥厚与甲状旁腺激素的关系

 对37例高血压病患者及20例正常人左室重量指数及甲状旁腺激素(PTH-M)进行了测定,结果表明高血压病患者甲状旁腺激素显著高于正常人,伴左室肥厚者与甲状旁腺激素显著相关,提示甲状旁腺激素可能促发高血压病左室肥厚.     

高血压病患者动态血压负荷与左室肥厚及颈动脉硬化的相关性研究

 目的 探讨高血压病患者动态血压负荷与左室肥厚及颈动脉硬化的相关性.方法 将明确诊断的高血压病患者65例行超声心动图和颈动脉超声、动态血压监测检查,将上述参数、血脂等指标进行比较.根据左室质量指数将患者分成左室肥厚组(n=20,占31%)和非左室肥厚组(n=45,占69%);根据颈动脉内-中膜厚度分为颈动脉粥样硬化组(n=23,占35%)及颈动脉正常组(n=42,占65%).结果 (1)左室肥厚组与非左室肥厚组临床指标比较差异无统计学意义(P>0.05); 左室肥厚组24 h收缩压负荷(24 h SBPL)、24 h舒张压负荷(24 h DBPL)、夜间收缩压负荷(nSBPL)、夜间舒张压负荷(nDBPL)、白天收缩压负荷(dSBPL)显著高于非左室肥厚组(P<0.01).(2)颈动脉粥样硬化组与颈动脉正常组临床指标比较差异无统计学意义(P>0.05);颈动脉粥样硬化组24 h SBPL、24 h DBPL、nSBPL、nDBPL显著高于颈动脉正常组(P<0.01).结论 (1)高血压病动态血压负荷异常者左室肥厚及颈动脉硬化的发生率增多;(2)高血压患者应常规进行颈动脉检查,尤其是伴有左室肥厚的高血压患者.     

高血压病左室肥厚对心室收缩期储备功能的影响

应用二维超声心动图Simpson法,在尚无临床心衰征象、静息左室射血分数正常的49例高血压病患者中,检测出伴有左室肥厚的28例病人在踏车极量运动时左心收缩功能的反应低于无左室肥厚组(21例)及年龄配对的血压正常对照组(23例)。提示伴有左室肥厚的高血压病患者收缩期储备功能已受损。     

Influence of left ventricular hypertrophy on infarct size and left ventricular ejection fraction in ST-elevation myocardial infarction

Background

Left ventricular hypertrophy (LVH) predisposes to larger infarct size, which may be underestimated by the left ventricular ejection fraction (LVEF) due to supranormal systolic performance often present in patients with LVH. The aim of the study was to compare infarct size and LVEF in patients with ST-segment elevation myocardial infarction (STEMI) and increased left ventricular mass on cardiac magnetic resonance (CMR).

Methods

The study included unselected group of 52 patients (61 ± 11 years, 69% male) with first STEMI who had CMR after median 5 days from the onset of the event. Left ventricular hypertrophy (LVH) was defined as left ventricular mass index exceeding 95th percentile of references values for age and gender. Infarct size was assessed with means of late gadolinium enhancement (LGE).

Results

LVH was found in 16 patients (31%). In comparison to the rest of the group, patients with LVH had higher absolute and relative infarct mass (p = 0.002 and p = 0.02, respectively). LVH was related to higher prevalence of microvascular obstruction and myocardial haemorrhage and higher number of LV segments with transmural necrosis (p = 0.02, p = 0.01 and p = 0.01, respectively). Despite marked difference in the infarct size between both studied subgroups there was no difference in LVEF and mean number of dysfunctional LV segments.

Conclusions

Patients with LVH undergoing STEMI have larger infarct size underestimated by the LV systolic performance in comparison to patients without LVH.     

Prognostic implications of stress Tc-99m tetrofosmin myocardial perfusion imaging in patients with left ventricular hypertrophy

Background  Left ventricular hypertrophy (LVH) is associated with an increased risk of cardiac death. Data on the prognostic value of myocardial perfusion imaging (MPI) in patients with LVH are limited. The aim of this study is to assess the independent value of stress technetium 99m tetrofosmin MPI in predicting the long-term mortality rate in patients with LVH. Methods and Results  We studied 177 patients (mean age, 59±12 years; 134 men) with LVH by electrocardiographic criteria who underwent dobutamine or exercise stress Tc-99m tetrofosmin MPI. Endpoints during follow-up were cardiac and all-cause death and hard cardiac events. A normal scan was detected in 42 patients (24%). Myocardial perfusion abnormalities were fixed in 59 patients (33%) and reversible in 76 (43%). Perfusion abnormalities were observed in a single-vessel distribution in 79 patients and in a multivessel distribution in 56. During a mean follow-up period of 5.5±2 years, 60 patients (34%) died. Death was considered cardiac in 42 patients (24%). Nonfatal myocardial infarction occurred in 10 patients (6%). The annual mortality rate was 1.4% in patients with normal perfusion, 3.2% in those with perfusion abnormalities in a single-vessel distribution, and 8% in those with a multivessel distribution. In a multivariate analysis independent predictors of death were age (risk ratio [RR], 1.05; 95% confidence interval [CI], 1.02–1.07), male gender (RR, 1.9; 95% CI, 1.1–3.6), hypercholesterolemia (RR, 1.7; 95% CI, 1.0–2.9), and abnormal perfusion (RR, 2.7; 95% CI, 1.5–4.8). Conclusion  In patients referred for stress MPI, LVH is associated with a high mortality rale, with approximately one third of patients dying over a period of 5 years. Stress Tc-99m tetrofosmin MPI provides independent information for predicting death in these patients. This study was supported in part by a limited publication grant from GE Healtheare.