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目的:探讨咪达普利和缬沙坦联合治疗对原发性高血压(EH)患者左心室肥厚(LVH)的逆转。方法:将137例伴LVH的EH患者随机分成咪达普利组、缬沙坦组和联合治疗组。设定血压达标值为收缩压(SBP)<140mmHg(1mmHg=0.133kPa)和舒张压(DBP)<90mmHg。3组患者分别口服起始剂量咪达普利10mg/d、缬沙坦80mg/d和咪达普利10mg/d加缬沙坦80mg/d。随访周期为2周,若血压未能达标,则增加剂量直至联合治疗,最大剂量为咪达普利20mg/d加缬沙坦160mg/d。3组患者均口服氢氯噻嗪12.5mg/d。总疗程24周。检测治疗前后24h动态血压、左室质量指数(LVMI)和心率(HR)。结果:①3组治疗后24hSBP、24hDBP均分别较治疗前显著降低(均P<0.01),而3组治疗前后24hSBP、DBP的降低幅度差异均无统计学意义(均P>0.05)。②3组治疗后LVMI和HR均分别较治疗前显著性降低(均P<0.01)。联合治疗组治疗前后LVMI和HR的降低幅度均分别大于咪达普利组和缬沙坦组,差别均具有统计学意义(均P<0.05)。结论:咪达普利和缬沙坦联合治疗在逆转LVH和抑制心脏交感活性方面较咪达普利或缬沙坦单药治疗具有更加显著的作用,且这些作用独立于降压疗效之外。
Objective: To investigate the reversal of left ventricular hypertrophy (LVH) in patients with essential hypertension (EH) by combination of imidapril and valsartan. Methods: 137 EH patients with LVH were randomly divided into Imidapril group, Valsartan group and combination therapy group. Set blood pressure compliance systolic blood pressure (SBP) <140mmHg (1mmHg = 0.133kPa) and diastolic blood pressure (DBP) <90mmHg. Three groups of patients were orally started with the dose of imidapril 10mg / d, valsartan 80mg / d and imidapril 10mg / d plus valsartan 80mg / d. Follow-up period of 2 weeks, if the blood pressure fails to meet the standard, then increase the dose until the combination therapy, the maximum dose of imidapril 20mg / d plus valsartan 160mg / d. Hydrochlorothiazide 12.5 mg / d was given orally in all three groups. The total course of 24 weeks. 24h ambulatory blood pressure, left ventricular mass index (LVMI) and heart rate (HR) were measured before and after treatment. Results: (1) The 24hSBP and 24hDBP in the three groups were significantly lower than those before treatment (all P <0.01), while there was no significant difference in the 24hSBP and DBP reduction between the three groups before and after treatment (all P> 0.05). ② The LVMI and HR of the three groups were significantly lower than those before treatment (all P <0.01). The decrease of LVMI and HR in the combined treatment group before and after treatment were greater than those in the Imidapril group and the Valsartan group, respectively (all P <0.05). CONCLUSION: Combination of imidapril and valsartan has a more significant effect than reversal or valsartan alone in reversing LVH and inhibiting cardiac sympathetic activity, and these effects are independent of antihypertensive effect.