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目的探讨氯沙坦对原发性高血压患者脉压(PP)及血管内皮功能的影响。方法将56例原发性高血压患者按照平均脉压大小分为PP≥60mmHg组(27例)、PP<60mmHg组(29例),分别予以氯沙坦50~100mg/d口服治疗24周,采用高分辨率超声系统检测肱动脉血流介导的血管舒张反应(FMD)评价血管内皮功能,比较两组治疗前后血压、脉压、血管内皮功能的变化。结果PP≥60mmHg组患者FMD受损程度较PP<60mmHg组更为显著(P<0.05);氯沙坦治疗24周后,两组患者脉压均有所降低(P<0.01)、FMD均有所改善(P<0.01),而较之PP<60mmHg组,PP≥60mmHg组患者脉压的降低及FMD的改善更为显著(P<0.05)。结论脉压增大可能加重原发性高血压患者的血管内皮功能障碍,氯沙坦在降低血压的同时可以降低脉压,改善血管内皮功能,脉压大的患者获益更多。
Objective To investigate the effects of losartan on pulse pressure (PP) and endothelial function in patients with essential hypertension. Methods Fifty-six patients with essential hypertension were divided into PP≥60mmHg group (n = 27) and PP <60mmHg group (n = 29) according to the mean pulse pressure. Patients were treated with losartan 50 ~ 100mg / d orally for 24 weeks, High-resolution ultrasound system was used to detect the vascular-mediated vasodilation (FMD) of brachial artery to evaluate the endothelial function. The changes of blood pressure, pulse pressure and endothelial function were compared between the two groups before and after treatment. Results The severity of FMD in PP≥60mmHg group was more significant than that in PP <60mmHg group (P <0.05). After 24 weeks of losartan treatment, the pulse pressure of both groups was decreased (P <0.01) (P <0.01). Compared with PP <60mmHg group, PP≥60mmHg group decreased pulse pressure and improved FMD more significantly (P <0.05). Conclusion Increased pulse pressure may aggravate vascular endothelial dysfunction in patients with essential hypertension. Losartan can lower pulse pressure and improve endothelial function while lowering blood pressure, and benefit patients with large pulse pressure.