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目的:评价缬沙坦单用或与苯那普利联合应用对原发性高血压患者血压和血管紧张素Ⅱ(Ang Ⅱ)及内洋地黄素水平的影响。方法:90例原发性高血压患者随机分成3组,每组30例。苯那普利组:每日口服苯那普利10 mg;缬沙坦组:每日口服缬沙坦80 mg;联合药物组:每日口服苯那普利10 mg和缬沙坦80 mg,持续12周。年龄和性别匹配的20例健康人作为正常对照组。结果:原发性高血压患者血浆内洋地黄素和Ang Ⅱ水平显著高于正常人。血浆内洋地黄素和Ang Ⅱ水平均与收缩压和舒张压水平呈显著正相关。在药物干预的6周内,3组患者的收缩压和舒张压均显著降低:6周后,苯那普利组和联合药物治疗组血压继续降低,但缬沙坦组血压不再继续降低。随着血压降低,苯那普利组和联合药物治疗组血浆Ang Ⅱ水平显著降低,而缬沙坦组血浆Ang Ⅱ水平显著升高。结论:缬沙坦单用或与苯那普利联合应用在6周内均能显著降低原发性高血压患者血压,但长时间单用缬沙坦则抗高血压作用减弱。在3组中,联合药物治疗组的抗高血压作用最佳,且能避免单用缬沙坦所致血浆Ang Ⅱ水平的升高。内洋地黄素可能参与原发性高血压的发病机制。因此,长期单用AT_1受体拮抗剂缬沙坦治疗原发性高血压可能是不恰当的。
Objective: To evaluate the effects of valsartan alone or in combination with benazepril on blood pressure and the levels of angiotensin Ⅱ (Ang Ⅱ) and endoxin in patients with essential hypertension. Methods: Ninety patients with essential hypertension were randomly divided into three groups (30 in each group). Benazepril group: oral benazepril 10 mg daily; valsartan group: daily oral valsartan 80 mg; combination group: daily oral benazepril 10 mg and valsartan 80 mg, For 12 weeks. Twenty healthy subjects were matched by age and gender as normal control group. Results: Plasma endorphin and Ang Ⅱ levels in patients with essential hypertension were significantly higher than those in normal subjects. Plasma endoxin and Ang Ⅱ levels were positively correlated with systolic and diastolic blood pressure levels. Systolic and diastolic blood pressure were significantly reduced in all three groups within 6 weeks of drug intervention: after 6 weeks, blood pressure in the benazepril group and the combination group continued to decline, but the blood pressure in the valsartan group did not decrease any further. With the decrease of blood pressure, plasma Ang Ⅱ levels in benazepril group and combination group were significantly decreased, but plasma Ang Ⅱ level in valsartan group was significantly increased. CONCLUSIONS: Valsartan alone or in combination with benazepril significantly reduced blood pressure in patients with essential hypertension in 6 weeks, but the antihypertensive effects of valsartan alone for a long time were weakened. In the three groups, the combination therapy group had the best antihypertensive effect and could avoid the increase of plasma Ang Ⅱ level caused by valsartan alone. Endoxin may be involved in the pathogenesis of essential hypertension. Therefore, the long-term use of AT_1 receptor antagonist valsartan in the treatment of essential hypertension may not be appropriate.