替米沙坦降压疗效的临床研究

目的前瞻性评估替米沙坦治疗原发性高血压的降压疗效和安全性. 方法 139例轻中度原发性高血压病人随机服用替米沙坦40～80 mg或福辛普利10～20 mg共26周,服药前、后行动态血压监测(ABPM),观察24 h SBP和DBP、谷峰比值、给药末6 h血压变化、降压有效率和不良反应.结果替米沙坦和福辛普利均能有效降低血压,26周治疗有效率分别为75%和72%(P>0.05),替米沙坦谷峰比值较福辛普利高(SBP72% vs 62%,P<0.05;DBP75% vs 63% P<0.05),且较福辛普利具有更强的降低清晨200-800血压的作用(P<0.05).替米沙坦不良反应发生率较少.结论替米沙坦治疗轻中度原发性高血压安全有效,耐受性好,可持续24 h理想的控制血压.     

坎地沙坦与福辛普利对高血压疗效的观察

目的前瞻性评估坎地沙坦治疗原发性高血压的降压疗效和安全性。方法130例轻中度原发性高血压患者随机服用坎地沙坦4~8mg或福辛普利10~20mg共20周,服药前后行动态血压监测(ABPM),观察24h收缩压(SBP)和舒张压(DBP)、谷峰比值、下一次给药前6h血压变化、降压有效率和不良反应。结果坎地沙坦和福辛普利均能有效降低血压,20周治疗有效率分别为74%和73%(P>0.05),坎地沙坦谷峰比值较福辛普利高(SBP:79%VS63%,P<0.05;DBP:79%vs62%P<0.05;),且较福辛普利具有更强的减低清晨2:00~8:00血压的作用(P<0.05)。坎地沙坦不良反应发生率较少。结论坎地沙坦治疗轻中度原发性高血压安全有效,耐受性好,可持续24h理想的控制血压。     

福辛普利与卡托普利对原发性高血压对照研究

目的　比较福辛普利与卡托普利治疗高血压的临床疗效。方法　 6 0例轻、中度高血压病人采用配对单盲对照法 ,分为福辛普利组和卡托普利组。分别观察治疗 6周后的坐位血压、动态血压、以及超声心动图变化。结果　福辛普利组与卡托普利组总有效率分别是 93 4 %和 90 % (P >0 0 5 )。谷峰比分别是 6 7 5 %和 4 2 3% (P <0 0 5 )。超声心动图两组两组心功能均有改善 ,唯组间相比差异不大。结论　福辛普利治疗高血压谷峰比好于卡托普利 ,每天一次可获稳定而持久降压效应。     

动态血压评价替米沙坦、氯沙坦治疗轻、中度高血压的临床疗效

目的　比较选择性血管紧张素Ⅱ受体拮抗剂替米沙坦、氯沙坦治疗轻、中度原发性高血压的疗效及安全性。方法　对 77例原发性高血压患者分成两组 ,分别予以替米沙坦 80mg,氯沙坦 5 0mg ,每日一次 ,6周后观察动态血压 (ABPM)评价降压效果。结果　替米沙坦和氯沙坦两组 2 4小时平均动态收缩压 (SBP)、舒张压 (DBP)均明显降低 ,替米沙坦 80mg的降压效果比氯沙坦 5 0mg更好 (P <0 .0 5 ) ,特别是在给药间期的最后 4～ 6小时 ,SBP/DBP替米沙坦降低了12 .3± 14 /7.2± 0 .9mmHg ,氯沙坦降低了 6.0± 1.6/3 .8± 0 .9mmHg(P <0 .0 5 )。结论　替米沙坦 80mg每日用药一次 ,可以保持正常的血压昼夜节律 ,提供 2 4小时血压控制的效果     

替米沙坦和缬沙坦治疗原发性高血压的疗效对照研究

目的 比较替米沙坦和缬沙坦对轻中度原发性高血压的降压疗效及安全性.方法 150例轻中度原发性高血压患者随机分成两组各75例,替米沙坦组40 mg/d,缬沙坦组80 mg/d,早餐后顿服,疗程均8周.治疗前后均进行血压、心率、血尿常规、肝肾功能、血生化、ECG及不良反应等检测.结果 两组均能有效降低血压(P<0.01),替米沙坦组总有效率为94.67%,缬沙坦组总有效率为89.33%,二者差别无统计学意义(P>0.05).两组治疗期间均未见明显不良反应.结论 替米沙坦和缬沙坦治疗轻中度高血压具有良好的降压效果,安全可靠,耐受性好,不良反应轻微.     

替米沙坦治疗轻中度高血压的临床疗效和安全性--多中心随机对照临床试验

目的：（1）比较替米沙坦40mg或80mg与氯沙坦50mg或100mg每天一次口服治疗轻中度高血压的疗效和安全性；（2）评价替米沙坦40mg每天一次口服治疗轻中度高血压的24h降压效果及谷／峰比值。方法：（1）多中心、随机、双盲、双模拟平行分组试验。330例轻中度高血压（95mm Hg≤舒张压＜110mm Hg，收缩压＜180mm Hg,1mm Hg=0.133kPa)患被随机分入替米沙坦组（164例）和氯沙坦组（166例），分别每天一次口服替米沙坦40mg或氯沙坦50mg。4周后如坐位舒张压≥90mm Hg，则改为替米沙坦80mg或氯沙坦100mg每天一次口服。（2）开放试验。同样条件的20例患服用替米沙坦40mg共6周，于替米沙坦治疗前后各进行24h动态血压监测。结果：（1）治疗8周末，替米沙坦组的坐位收缩压及舒张压下降幅度大于氯沙坦组（12．5mm Hg vs 9.4mm Hg,P=0.037及10.9mm Hg vs 9.3mm Hg,P=0.030);(2)替米沙坦降低轻中度高血压的总有效率高于氯沙坦（70．1％ vs 58.7%,P=0.020);(3)替米沙坦级瑟氯沙坦组的不良事件发生率相似（23．2％ vs 22.9%,P=0.952);(4)替米沙坦40mg每天一次口服，其收缩压的谷／峰比值为66．5％，舒张压的谷／峰比值为76．8％；24h平均血压下降10．2／7．8mm Hg，用药末6h的平均血压下降10.0/9.2mm Hg。结论：（1）替米沙坦40mg或80mg每天一次口服治疗轻中度高血压安全有效；（2）替米沙坦适合每天一次服用，其降压作用可维持24h。     

替米沙坦氢氯噻嗪胶囊与替米沙坦片治疗轻中度原发性高血压的临床研究

目的评价替米沙坦氢氯噻嗪胶囊治疗轻中度原发性高血压的有效性和安全性。方法符合入排标准的轻中度原发性高血压患者300例（8家医院）,先后经2周清洗期和4周替米沙坦片单药治疗期后,血压未达标者（90mmHg≤舒张压（diastolic blood pressure,DBP）〈110mmHg并且收缩压（systolic blood pressure,SBP〈180mmHg）按随机双盲对照原则分为两组,分别给予替米沙坦氢氯噻嗪胶囊（A组）与替米沙坦片（B组）。主要观察指标是双盲治疗8周后较开始双盲治疗时DBP绝对值的变化。其他观察指标还包括血生化指标、心电图、24小时动态血压（ABPM）参数等。结果 （1）共213例（A组即替米沙坦氢氯噻嗪胶囊组108例,B组即替米沙坦片组105例）完成该研究,33例失访,1例发生严重不良事件——心肌梗塞（研究者判断与本研究药物无关）。（2）双盲治疗8周后DBP绝对值的变化两组间有显著性差异（A组（12.66±10.76）mmHg,B组（7.89±12.15）mmHg,P=0.0203）。（3）A组总有效率、平均血压下降值、达目的的血压率均显著高于B组（P均〈0.05）。两组谷峰比值均〉50%。（4）两组不良事件发生率（A组21.8%;B组22.1%,P=0.9461）及与研究药物有关不良事件发生率（A组8.1%;B组9.8%,P=0.6264）均无显著性差异。结论替米沙坦氢氯噻嗪胶囊与替米沙坦片（80mg）对轻、中度原发性高血压患者有平稳长效的降压疗效和相同的安全性,且替米沙坦氢氯噻嗪胶囊的疗效优于单方的替米沙坦片。     

替米沙坦治疗超重/肥胖高血压患者的效果

目的探讨替米沙坦对超重/肥胖高血压患者血压的影响。方法原发性高血压1~2级伴有超重/肥胖患者75例,治疗组(n=45)口服替米沙坦,对照组(n=30)服用缬沙坦或厄贝沙坦或贝那普利,高血压1级者单药治疗,高血压2级者联合用药于前述药物基础上加氨氯地平。观察降压疗效6周。结果替米沙坦组舒张压下降幅度(9.96±2.13)mmHg明显优于对照组(8.13±2.42)mmHg(P<0.05)。两组收缩压下降明显,但两组间无明显差异。结论替米沙坦能更有效控制超重/肥胖高血压患者的血压,可能通过激活过氧化物酶体增殖物激活受体-γ(PPAR-γ)等多途径实现了降压效果。     

多沙唑嗪控释片与苯那普利对轻中度原发性高血压疗效的对比观察

目的 :确定多沙唑嗪 (doxazosin)控释片对轻、中度原发性高血压的降压疗效及耐受性。方法 :选取 41例坐位舒张压 95～ 115mmHg( 1mmHg =0 133kPa)的轻、中度原发性高血压患者 ,随机分为多沙唑嗪控释片组 ( 4mg/d)与苯那普利 (benazepril)组 ( 10mg/d)。于安慰剂期末及治疗 2、4、6、8周测诊室血压、心率并记录症状、体征及不良反应。结果 :8周治疗总有效率 :多沙唑嗪控释片组 6 1 9% ,苯那普利组 6 5 0 %。 2组坐位血压较基础血压均明显下降 ,2组下降幅度相似。不良反应多沙唑嗪控释片组较苯那普利组少 ( 14 3%vs .45 0 % ,P <0 0 5 )。 2组均无体位性低血压发生。结论 :多沙唑嗪控释片 4mg ,每日 1次 ,治疗轻、中度原发性高血压患者具有疗效肯定 ,耐受性好 ,不良反应少的特点 ;经过 8周的治疗证明 ,服用 4mg多沙唑嗪控释片的降压效果与服用 10mg的苯那普利片相同     

国产拉西地平对广西轻中度原发性高血压50例患者24 h动态血压的影响

目的探讨拉西地平(司乐平)对广西轻中度原发性高血压的降压疗效。方法选50例轻中度原发性高血压患者采用自身对照开放法,停用原来降压药物2周后随诊血压(CBP)仍≥160/95 mmHg(1 mmHg=0.133 kPa)者口服拉西地平4～8 mg/d共4周,期间不服用其他降压药。结果治疗4周后随诊血压(CBP)降低总有效率为88%,动态血压曲线明显降低,谷峰比值收缩压为65.2%,舒张压为61.1%。结论国产拉西地平4～8 mg/d对轻中度原发性高血压患者具有安全有效的降压作用,耐受性好,不良反应少。     

Combination treatment with telmisartan and hydrochlorothiazide in black patients with mild to moderate hypertension

BACKGROUND: Hydrochlorothiazide (HCTZ) is commonly used to treat black patients with hypertension. To avoid the metabolic disturbances associated with high-dose HCTZ, blood pressure control may be achieved by combining low doses with another antihypertensive. HYPOTHESIS: The study was undertaken to assess the tolerability and antihypertensive dose-response efficacy of telmisartan and HCTZ and their combination in black patients with mild to moderate hypertension (mean supine blood pressure 140/95-200/114 mmHg). METHODS: Following a 4-week, single-blind, placebo run-in period, 222 black patients were randomized to once-daily treatment with one of 20 different double-blind combinations of telmisartan (0, 20, 40, 80, 160 mg) and HCTZ (0, 6.25, 12.5, 25 mg) for 8 weeks. Blood pressure was measured at baseline and after 2, 4, and 8 weeks. RESULTS: Telmisartan 80 mg/HCTZ 12.5 mg reduced supine trough diastolic blood pressure (DBP)--primary efficacy parameter--by 13.3 mmHg, and supine trough systolic blood pressure (SBP) by 21.5 mmHg. These reductions represented benefits of 13.7/8.7 mmHg over telmisartan 80 mg and 12.3/8.1 mmHg over HCTZ 12.5 mg (p < 0.01). Telmisartan 40 mg/HCTZ 12.5 mg reduced supine trough SBP/DBP by 14.3/10.0 mmHg, amounting to 12.3/3.3 mmHg more than telmisartan 40 mg and 5.1/4.8 mmHg more than HCTZ 12.5 mg. This reached significance for the comparisons with telmisartan 40 mg for SBP and HCTZ 12.5 mg for DBP (p<0.05). A response surface analysis and therapeutic response rates confirmed the additive antihypertensive effects of telmisartan and HCTZ. All treatments were well tolerated, with side-effect profiles comparable with placebo. Adverse events were mainly transient and of mild to moderate severity. CONCLUSIONS: Telmisartan 80 mg combined with HCTZ 12.5 mg is effective and well tolerated in black patients with mild to moderate hypertension, providing greater antihypertensive activity than the corresponding monotherapies.     

替米沙坦对老年高血压患者血压晨峰与心脏重构的影响

目的：探讨替米沙坦对老年高血压患者血压晨峰现象及心脏重构的影响。方法：120例老年高血压患者根据血压晨峰是否超过23.58mmHg分为晨峰组（60例）与非晨峰组（60例）,均予以替米沙坦80～160mg/d治疗6月,治疗前后行动态血压、心脏超声检查。结果：与血压非晨峰组比较,晨峰组左室肥厚发生率（36.7%比51.6%）、左房内径扩大率（26.7%比41.7%）明显升高（P均〈0.01）;与治疗前比较,晨峰组经替米沙坦治疗6月后收缩压（SBP）差值[（32.7±4.2）mmHg比（21.2±6.7）mmHg]、舒张压（DBP）差值[（20.3±3.6）mmHg比（13.5±7.4）mmHg]明显降低（P〈0.01）,而非晨峰组SBP、DBP差值较治疗前无明显降低（P〉0.05）,两组替米沙坦治疗6月后左室重量指数均明显降低（P〈0.05）。结论：老年高血压患者血压晨峰程度与心脏重构密切相关,替米沙坦能有效控制老年高血压患者晨峰现象,逆转左室肥厚。     

Fosinopril monotherapy: Relationship between blood pressure reduction and time of administration

The time to peak antihypertensive effect and the trough-to-peak ratio were determined in 64 Caucasian patients (19 men, 45 women) with mild to moderate hypertension [supine diastolic blood pressure (DBP) 95 to 115 mmHg]. They received placebo or fosinopril 10, 20, or 40 mg once daily for 4 weeks. The study consisted of a 4-week placebo lead-in, 4 weeks' double-blind treatment, and a 1-week placebo washout period. Vital signs were determined biweekly before dosing, and blood pressures were measured every 1 to 2 h during two 27-h periods at the beginning and end of treatment. After the first and last doses of all three regimens, the peak effect on blood pressure occurred 5 to 7 h after all three dosages. Neither peak nor trough blood pressure changes showed a clear dose-response relationship. Trough to peak ratios for the first dose, corrected for placebo effects, were 79% for fosinopril 10 mg, 48% for fosinopril 20 mg, and 74% for fosinopril 40 mg, and the trough-to-peak ratios for the last dose were 41% for fosinopril 10 mg, 32% for fosinopril 20 mg, and 44% for fosinopril 40 mg. In the 38 responders among the 48 patients receiving fosinopril (supine DBP decrease of at least 5 mmHg at 24 h postdose), trough-to-peak rations ranged from 50 to 81%, and the range indicates that fosinopril is efficacious when administered once daily. Adverse effects were mild to moderate, and no patient discontinued treatment. Changes in the laboratory test results, electrocardiograms, or the results of physical examinations were unremarkable. Once-daily fosinopril 10, 20, or 40 mg effectively and safely controlled blood pressure in patients with mild to moderate essential hypertension.     

Angiotensin II receptor antagonist telmisartan in isolated systolic hypertension (ARAMIS) study: efficacy and safety of telmisartan 20, 40 or 80 mg versus hydrochlorothiazide 12.5 mg or placebo

OBJECTIVE: To identify telmisartan doses that are more effective than placebo and non-inferior to hydrochlorothiazide (HCTZ) 12.5 mg, and are well tolerated, in lowering systolic blood pressure (SBP) in patients with isolated systolic hypertension (ISH). PATIENTS AND METHODS: A 2-4-week single-blind placebo run-in was followed by randomization of 1039 patients (age 36-84 years) with ISH [seated SBP 150-179 mmHg and seated diastolic blood pressure (DBP) < 90 mmHg] to once-daily double-blind treatment with telmisartan 20, 40 or 80 mg, HCTZ 12.5 mg, or placebo. The change in seated trough SBP after 6 weeks compared with baseline was the primary end point. Secondary end points were the percentage achieving the target fall in SBP and the change from baseline in seated trough DBP. Incidence and severity of adverse events and physical examination and laboratory parameters were monitored for the safety evaluation. RESULTS: Baseline demographics in telmisartan 20 mg (n = 206), 40 mg (n = 210), 80 mg (n = 207), HCTZ 12.5 mg (n = 205) and placebo (n = 211) treatment groups were comparable: (mean +/- SD) age, 63.0 +/- 10.9 years; SBP, 162.9 +/- 8.1 mmHg; and DBP 83.4 +/- 5.0 mmHg. No previous antihypertensive therapy had been received by 66% of the patients. Mean reductions in seated trough SBP (adjusted for baseline and country) were: telmisartan 20 mg, 15.6 mmHg (n = 204); 40 mg, 17.9 mmHg (n = 209); and 80 mg, 16.9 mmHg (n = 205), compared with placebo, 11.4 mmHg (n = 208), and HCTZ 12.5 mg, 15.7 mmHg (n = 204). The target fall in seated trough SBP (< or =140 mmHg or reduction by > or =20 mmHg) was achieved in 46.6% (telmisartan 20 mg), 51.7% (telmisartan 40 mg), 53.9% (telmisartan 80 mg), 27.4% (placebo) and 42.7% (HCTZ 12.5 mg); the response rate was significantly higher for telmisartan 80 mg than for HCTZ 12.5 mg (P = 0.03). All-causality adverse events occurred in 19.9, 17.6 and 20.3% receiving telmisartan 20, 40 and 80 mg, respectively; 20.9% receiving placebo and 22.0% receiving HCTZ 12.5 mg. No drug-related serious adverse events occurred. CONCLUSIONS: All doses of telmisartan (20-80 mg) were significantly superior to placebo in reducing SBP in patients with ISH and clinically comparable to HCTZ 12.5 mg. Tolerability of telmisartan was similar to that of placebo.     

Telmisartan in monotherapy of essential hypertension in young men--time of drug administration and 24-hours blood pressure and heart rate

42 men, aged 19-35 years (mean 26.3), with mild or moderate essential hypertension (DBP 95-110 mmHg), were treated with telmisartan (40 mg or 80 mg ) once daily in the morning (6 and 7 a.m.) for at least 6 weeks and for next 6 weeks and after that administration time was changed to evening dose (6-7 p.m.) 24-hours ABPM (SpaceLabs) was performed in all patients on last day of each period. Obtained recordings were compared in different periods of time: 6.00 a.m. -10.59 p.m., 11.00 p.m-5.59 a.m., 2.00-5.59 a.m., 6.00-12.00 a.m, 3.00-7.00 p.m. The SBP values in all time intervals were comparable (differences statistically not significant). A statistically significant reduction of the DBP in the time interval 6:00-12:00 a.m. was found in patients treated with telmisartan in the morning. The heart rate of the patients who received telmisartan has not been affected by the treatment schedule and remained comparable. CONCLUSIONS: 1.) The time of the day administration does not affect the diurnal and night hypotensive efficacy of telmisartan. 2.) According to the results of this study, patients with the essential hypertension should receive telmisartan as monotherapy in the morning.     

Comparison of telmisartan versus losartan: meta-analysis of titration-to-response studies

OBJECTIVES: To compare the ability of telmisartan and losartan to reduce mean diastolic blood pressure (DBP) during the last 6 h of the 24-h dosing interval in a prospectively planned meta-analysis of ambulatory blood pressure monitoring (ABPM) data from two independent studies. METHODS: Data were from two independent randomized, double-blind, double-dummy, titration-to-response studies conducted in patients with mild-to-moderate hypertension (seated cuff DBP 95-109 mmHg, 24-h mean ambulatory DBP >or=85 mmHg). After a 4-week placebo run-in period, patients received once-daily telmisartan 40 mg or losartan 50 mg, with up-titration after 4 weeks to telmisartan 80 mg or losartan 100 mg, respectively, if seated trough cuff DBP >or=90 mmHg. Blood pressures were recorded using ABPM immediately before randomization and after 8 weeks of active treatment. In addition, seated trough cuff blood pressures were measured at baseline and after 4 and 8 weeks of active treatment. RESULTS: Titration to the higher dose was required in 60.1% of telmisartan patients and 69.5% of losartan patients (P=0.01). Reductions from baseline in the last 6 h mean ambulatory DBP with telmisartan and losartan were 6.6+/-0.4 and 5.1+/-0.4 mmHg, respectively (P<0.01, adjusted for baseline and study); the effects were homogeneous across the two studies. During the last 6 h of the 24-h dosing interval, telmisartan produced greater reductions in each of the observed hourly mean ambulatory DBP values. Telmisartan-induced reductions were also greater for the majority of the observed hourly mean ambulatory DBP values over the entire 24-h dosing interval. Reductions from baseline in the last 6 h adjusted mean ambulatory systolic blood pressure (SBP) for telmisartan and losartan were 9.9+/-0.6 and 7.8+/-0.6 mmHg, respectively (P=0.01). The 24-h profiles of ambulatory SBP hourly mean reductions were similar to those for DBP. Both telmisartan and losartan were found to be safe and well tolerated. CONCLUSIONS: Telmisartan 40/80 mg is superior to losartan 50/100 mg in controlling DBP and SBP during the last 6 h of the 24-h dosing interval.     

氯沙坦治疗原发性高血压的疗效和对尿清蛋白的影响

目的 探讨氯沙坦治疗轻、中度原发性高血压的疗效和对尿清蛋白的影响。方法 82例高血压患者随机分两组,氯沙坦组(治疗组,43例)50～100mg·d-1口服,疗程12周;培哚普利组(对照组,39例)4～8mg·d-1服,疗程12周。治疗前后做动态血压及肝、肾功能、血脂、血糖等检查,测定尿液中清蛋白(Alb),血清肌酐(Scr)及血尿素氮(BUN)的变化。结果 治疗组降压总有效率75％(33例),降压幅度(以mmHg计)收缩压(SBP)为21.舒张压(DBP)为13,谷/峰(T/P)比值SBP为0.73,DBP为0.71。对照组总有效率74％(29例),降压幅度SBP为22,DBP为12,谷/峰比值SBP为O.71,DBP为O.72,两组结果相似。治疗后两组尿Alb减低(P<0.01)。氯沙坦不良反应轻微。结论 氯沙坦对高血压有确切疗效,干咳发生率低,减少尿清蛋白的排泄,对肾脏有保护作用。     

氨氯地平加替米沙坦对轻、中度高血压的疗效及与AVP和NO的关系

目的 观察氨氯地平加替米沙坦对轻、中度高血压的疗效，探讨高血压患者血管加压素(AVP)和一氧化氮（NO）的变化与疗效的关系。方法 将60例轻、中度高血压病患者（包括:正在服用降压药的高血压病患者和新发病例没有服用降压药的患者）随机分为:氨氯地平组，替米沙坦组和氨氯地平＋替米沙坦组（氨+替组）,每组各20例。测定各组治疗前后血压的变化。采用放免法、比色法测定各组患者治疗前后血浆AVP和NO的含量。结果 ①氨氯地平组、替米沙坦组及氨＋替组治疗前收缩压（SBP）分别为:(146.31±3.15)mmHg、(145.92±2.71)mmHg及(146.00±2.42)mmHg；舒张压(DBP)分别为:(93.77±2.39)mmHg、(92.54±2.68)mmHg及(94.93±1.15)mmHg。在治疗6个月后，SBP分别为:(126.69±1.74)mmHg、(126.08±1.52)mmHg及(102.71±2.20)mmHg；DBP分别为:(80.76±1.13)mmHg、(81.00±0.80)mmHg和(76.11±1.36)mmHg，与治疗前比较明显降低（P<0.05）。氨+替组患者的SBP和DBP均明显低于氨氯地平组和替米沙坦组（P<0.05）；氨氯地平组与替米沙坦组比较无显著差异。②治疗1月、2月末，氨+替组患者的血压达标率均明显高于氨氯地平组和替米沙坦组（P<0.05）；氨氯地平组和替米沙坦组比较无显著差异。③氨氯地平组、替米沙坦组及氨＋替组治疗前血浆NO的含量分别为:(12.77±0.23)μmol/L、(11.68±0.35)μmol/L及(10.09±1.04)μmol/L；治疗6个月后其含量分别为:(18.50±2.14)μmol/L、(19.07±1.96)μmol/L及(25.47±1.84)μmol/L，与治疗前比较差异显著（P<0.05）。氨+替组患者NO的含量明显高于氨氯地平组和替米沙坦组（P<0.05）；氨氯地平组和替米沙坦组比较无显著差异。④氨氯地平组、替米沙坦组及氨＋替组患者治疗前血浆AVP的含量分别为:(34.71±4.36)ng/L、(33.07±3.77)ng/L及(35.06±4.12)ng/L；治疗6个月后分别为:(22.35±2.71)ng/L、(24.12±3.11)ng/L及(17.98±1.79)ng/L,与治疗前比较差异显著（P<0.05）。氨+替组血浆AVP的含量低于氨氯地平组和替米沙坦组（P<0.05），氨氯地平组和替米沙坦组组间比较无显著差异。结论 ①3个组均能有效控制血压，但氨+替组的降压效果更佳。②3个组在显著降低血压的同时，均伴有血浆AVP含量降低和血浆NO含量增高，氨+替组的效果更明显，提示AVP和NO参与了高血压的发生发展，可作为观察高血压疗效的指标。     

Freehand three-dimensional echocardiographic evaluation of the effect of telmisartan compared with hydrochlorothiazide on left ventricular mass in hypertensive patients with mild-to-moderate hypertension: a multicentre study

Antihypertensive efficacy, effects on left ventricular mass index (LVMI) and tolerability of telmisartan, an angiotensin II receptor blocker, were compared with those of hydrochlorothiazide (HCTZ). Adult patients with mild-to-moderate hypertension and an optimal acoustic window by two-dimensional echocardiography were randomised at baseline to 12 months' double-blind, once-daily treatment with telmisartan 80 mg or HCTZ 25 mg. Two-dimensional echocardiography and freehand precordial three-dimensional echocardiography and 24-h ambulatory blood pressure monitoring were performed at baseline and after treatment. Of the 41 telmisartan group patients and 28 HCTZ group patients, 40 and 25, respectively, completed the study. Following treatment, 24-h mean SBP (telmisartan 157 +/- 11 vs 133 +/- 7 mmHg, P<0.001; HCTZ 154 +/- 10 vs 144 +/- 11 mmHg, P<0.003) and DBP (telmisartan 96 +/- 6 vs 83 +/- 5 mmHg, P<0.001; HCTZ 95 +/- 7 vs 87 +/- 8 mmHg, P<0.003) were significantly reduced. Telmisartan produced significantly greater 24-h mean SBP and DBP reductions than HCTZ (P<0.001). LVMI was significantly reduced by telmisartan (141 +/- 16 vs 125 +/- 19 g/m2, P<0.001), but not by HCTZ (139 +/- 20 vs 135 +/- 22 g/m(2)). Incidences of adverse events in both the treatment groups were low; two cases of hypokalaemia occurred with HCTZ. In conclusion, telmisartan 80 mg was well tolerated and significantly reduced SBP, DBP and LVMI after 12 months' treatment compared with HCTZ.