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目的探讨血管紧张素Ⅱ1型受体拮抗剂氯沙坦治疗对血压达标及左心室舒张功能的影响。方法多中心、开放、自身前后对照试验设计,给予患者52周抗高血压治疗,其中初治的高血压患者给予氯沙坦为主的联合降压方案;而经治的高血压患者血压仍未达标者加用氯沙坦等联合降压。将70例患者分为两组,<65岁组(40例)目标血压<140/90mmHg(1mmHg=0.133kPa),≥65岁组(30例)血压达标为<150/90mmHg。试验最终有55.71%的患者为单药氯沙坦治疗,25.71%及18.58%的患者分别为2种和3种以上药联合治疗。达标率<65岁组为87.50%,≥65岁组为83.33%。结果经氯沙坦治疗52周后患者左心室的室间隔和左心室后壁厚度均有明显的改善。在<65岁组二尖瓣舒张早期血流峰速(E)/舒张晚期血流峰速(A)比值(E/A)增加,而在≥65岁组左心室射血分数有所增加,其增加量与舒张压降低幅度呈负相关。结论以氯沙坦为基础的联合降压方案在抗高血压治疗达标的同时,能够改善左心室的舒张功能。但随年龄的增长,药物对其病程的干预及逆转作用并不完全一致。
Objective To investigate the effects of losartan, an angiotensin Ⅱ type 1 receptor antagonist, on blood pressure compliance and left ventricular diastolic function. METHODS: A multicenter, open, and self-controlled trial designed 52-week antihypertensive treatment of patients with untreated hypertension, losartan-based combination regimen; and those who did not Add Losartan combined with antihypertensive. 70 patients were divided into two groups. The target blood pressure was less than 140/90 mmHg (1mmHg = 0.133kPa) in the group of 65 years old (40 cases) and the blood pressure was less than 150/90 mmHg in the group of more than 65 years old (30 cases). Finally, 55.71% of the patients were treated with losartan alone, while 25.71% and 18.58% were combined with two or more than three drugs respectively. Compliance rate <65 years old group was 87.50%, ≥ 65 years old group was 83.33%. Results After 52 weeks of losartan treatment, the left ventricular septal thickness and left ventricular posterior wall thickness were significantly improved. The mitral diastolic velocity (E) / diastolic velocity (A) ratio (E / A) increased at 65 years old, while left ventricular ejection fraction increased at 65 years old, The increase was negatively correlated with the decrease of diastolic blood pressure. Conclusion Losartan-based combined antihypertensive regimen can improve diastolic function of left ventricle while achieving antihypertensive treatment. However, with the increase of age, the intervention of the drug on its course and the reversal effect are not exactly the same.