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目的:探讨替米沙坦对伴有冠心病的原发性高血压(EH)患者左室重构、超敏-C反应蛋白(hs-CRP)及心功能的影响。方法:选择并发有冠心病的原发性高血压患者120例,随机分为替米沙坦组(49例)和贝那普利组(44例),分别予以替米沙坦口服(80~160 mg/d)和贝那普利口服(10~20 mg/d),每日1次,疗程均为24周,治疗前后分别测血压、血脂、尿酸(UA)、hs-CRP和超声心动图测定左室结构和功能,对比分析治疗前、后各指标的差异。结果:①与治疗前比较,替米沙坦组和贝那普利组治疗后收缩压和舒张压明显下降(161/101至130/83 mmHg;160/102至131/85 mmHg,均为P<0.01);②替米沙坦治疗后,三酰甘油(TG)、舒张期室间隔厚度(IVST)、舒张期左室后壁厚度(LVPWT)、左室舒张末内径(LVEDD)、A/E明显降低(P<0.05);UA、左室射血分数(LVEF)、hs-CRP及左室质量指数(LVM I)下降非常显著(P<0.01);贝那普利组治疗后无明显的变化,但hs-CRP、LVM I明显下降(P<0.05);两组治疗后比较,替米沙坦组UA、LVM I明显下降及LVEF明显改善(P<0.05);③直线相关分析显示:hs-CRP与LVM I呈正相关(r=0.61,P<0.05)。结论:替米沙坦和贝那普利均能有效降低EH患者的血压水平。与贝那普利比较,替米沙坦还能显著降低hs-CRP水平以及改善三酰甘油代谢和血UA代谢,并使EH患者LVH显著逆转和心功能明显改善。
Objective: To investigate the effect of telmisartan on left ventricular remodeling, high-sensitivity c-reactive protein (hs-CRP) and cardiac function in patients with essential hypertension (EH) accompanied by coronary heart disease. Methods: One hundred and twenty patients with essential hypertension complicated with CHD were randomly divided into telmisartan group (n = 49) and benazepril group (n = 44) 160 mg / d) and benazepril (10-20 mg / d) once daily for 24 weeks. Blood pressure, blood lipid, uric acid (UA), hs-CRP and echocardiography were measured before and after treatment Figure determination of left ventricular structure and function, comparative analysis before and after treatment of the indicators of differences. Results: ①Compared with pretreatment, the systolic and diastolic blood pressures decreased significantly after treatment (161/101 to 130/83 mmHg; 160/102 to 131/85 mmHg, all P <0.01). ② After treatment with telmisartan, triglyceride (TG), IVST, LVPWT, LVEDD, A / (P <0.05). The decrease of UA, LVEF, hs-CRP and LVM I were significant (P <0.01), and there was no significant difference after benazepril treatment (P <0.05). The levels of UA, LVM I and LVEF were significantly decreased in both groups after treatment (P <0.05). ③The linear correlation analysis showed that the levels of hs-CRP and LVM I were significantly decreased There was a positive correlation between hs-CRP and LVM I (r = 0.61, P <0.05). Conclusion: Telmisartan and benazepril can effectively reduce the blood pressure of EH patients. Compared with benazepril, telmisartan can also significantly reduce the level of hs-CRP and improve the metabolism of triacylglycerol and blood UA metabolism, and make EH patients with significant reversal of LVH and cardiac function improved significantly.