坎地沙坦联合氨氯地平治疗高血压并逆转左室肥厚改善心功能的疗效观察

目的探讨对血管紧张素转化酶抑制药不能耐受患者应用坎地沙坦联合氨氯地平治疗高血压的降压效果、安全性与逆转高血压心肌肥厚和改善心功能的疗效。方法将166例原发性高血压并左室肥厚患者随机分为坎地沙坦+氨氯地平组(A组)和氨氯地平+卡维地洛组(B组),观察血压、不良反应,并作多普勒超声心动图检测。结果①两组治疗12个月后,24小时收缩压与舒张压均有明显下降(P<0.01);但是两组治疗后24小时收缩压与舒张压差异无显著性(P>0.05)。②A组治疗12个月后,左室重量指数下降显著(P<0.01);而在B组治疗12个月后左室重量指数无明显下降(P>0.05);治疗12个月后,A组左室重量指数较B组下降明显(P<0.01)。③A组患者治疗后的心排血量、左室射血分数、舒张早期与舒张晚期峰值流速的比值均不同程度得到明显改善(P<0.01),B组治疗前后差异无统计学意义(P>0.05)。结论原发性高血压患者经坎地沙坦加氨氯地平治疗12个月后,可使其左室肥厚显著逆转及左室功能显著改善。

Efficacy of Candesartan in Combination with Amlodipine for the Treatment of Essential Hypertension and Left Ventricular Hypertrophy and Improving Cardiac Function

Objective To explore the antihypertensive effect and safety of candesartan in combination with amlodipine for the treatment of essential hypertension and the effect of reversing the ventricular hypertrophy and improving cardiac function in patients with no tolerance of angiotension-converting enzyme inhibitor(ACEI).Methods 166 patients with essential hypertension and left ventricular hypertrophy were randomly divided into candesartan + amlodipine group(A group) and amlodipine + carvedilol group(B group),blood pressure,adverse reactions were observed and Doppler echocardiography was detected.Results ①The 24 h SBP and 24 h DBP of patients in two groups decreased significantly after 12 months(P<0.01),but there was not markedly difference in decreasing amplitude between the two groups at 24 h(P>0.05).②LVMI and HR of patients in A group decreased significantly after 12 months(P<0.01),but there was no significant decline in B group(P>0.05),and the decreasing amplitude of LVMI and HR of patients in A group were markedly higher than those of B group(P<0.01).③The cardiac output,left ventricular ejection fraction,peak early diastolic and late diastolic velocity ratio of patients in A group were significantly improved by different degrees(P<0.01),in B group there was no significant difference before and after treatment(P>0.05).Conclusion The patients with essential hypertension are treated by candesartan in combination with amlodipine for 12 months,the left ventricular hypertrophy is reversed significantly and the left ventricular function is improved significantly.