哌唑嗪对单纯收缩期高血压患者左室肥厚的影响

以超声心动图观察哌唑嗪对48例单纯收缩期高血压(ISH)和32例舒张期高血压(DH)患者左室肥厚的影响。ISH组室间隔和左室后壁分别减少2.5和1.8mm(P均<0.01),左室重量指数下降61g/m~2(P<0.01),左心收缩和舒张功能改善。DH组室间隔肥厚减轻,但左室重量下降及左室舒张功能改善的幅度均小于ISH组。     

高血压病程对左室肥厚和功能的影响

采用超声心动图对高血压病患者进行检测，以观察不同病程对左室肥厚（LVH）及功能参数的影响。高血压甲组（病程≤10年）及乙组（病程＞10年）的室间隔厚度（IVSTd），左室后壁厚度（PWPd）、左室舒张期内径（LVEDD）和左室重量指数（LVWI）均明显高于血压正常组。高血压乙组的IVSTd，LVEDD和LVWI亦明显高于甲组。高血压组IVH总的检出率为40．8％。甲、乙两组分别为33．3％和48．9％，LVH类型在两组间无明显差别。高血压甲、乙两组的左室舒张功能受损，主要表现为二尖瓣舒张晚期血流速度峰值（A）增加,E／A比值减少（E为早期峰值）。高血压乙组的左室射血分数（LVEF）较正常血压组低，甲组与正常血压组无差别。结果揭示，高血压病程是影响LVH和左室功能的一个重要因素。     

尼群地平和苯那普利对高血压患者血压、左室肥厚及心功能的影响

本文应用尼群地平和苯那普利(洛汀新)治疗原发性高血压患者48例,旨在探讨两者合用在降压的同时是否有相加的逆转左室肥厚(LVH)作用。1　对象与方法1.1　对象原发性高血压伴LVH患者48例,女23例,男25例,年龄38～70岁。均符合WHO的高血压诊断标准。其中期高血压20例,期者28例,病程6～18年。入选前排除慢性肺部疾患,肾功能不全及其他心脏病。血、尿常规,电解质均正常。1.2　方法1.2.1　分组:患者被随机分为两组,A组23例,男13例,女10例,年龄在54.1±7.2岁,病程10.0±5.7年。B组25例,男14例,女11例,年龄53.4±6.3岁,病程10.9±4.5年。1.2.2　…     

左室重构对高血压患者心功能的影响

2002年10月-2005年10月，我们观察了左室重构对高血压患者心功能的影响。现报告如下。     

长期降压治疗对高血压病患者不同类型左室肥厚的影响

以超声心动图观察62例接受治疗的高血压合并左室肥厚(LVH)的患者,平均随访2.2年。对称性肥厚组(n=34)的室间隔(IVST)、左室后壁(PWT)及左室重量(LVM)分别下降19.0%、21.2%和15.9%(P 均<0.01)。上述指标下降的幅度与各自治疗前水平、收缩压下降值及服药时间有关。不对称性肥厚组(n=28)各指标无明显变化。两组患者舒张功能均有改善,但收缩功能未变。     

螺内酯联合美托洛尔对老年慢性心力衰竭患者左室重构及心功能的影响

目的探讨螺内酯和美托洛尔联合应用对老年慢性心力衰竭(CHF)患者左室重构及心功能的影响。方法选取该院2012年11月至2013年11月收治的符合入选要求的60例老年CHF患者,将其随机分为对照组和观察组各30例。对照组给予常规的治疗药物治疗(血管紧张素转换酶抑制剂、阿司匹林、洋地黄、硝酸异山梨醇及利尿剂);观察组在对照组的基础上加服螺内酯与美托洛尔丸进行治疗。治疗周期为12 w。观察比较治疗过程中两组患者治疗前后临床治疗疗效、左心室功能等各项指标。结果观察组临床治疗疗效、左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)及左室缩末期容积(LVESV)等各项指标显著优于对照组(P0.05)。结论联合应用螺内酯和美托洛尔可以更好地抑制老年CHF患者左室重构,改善心脏功能,安全有效,值得临床推广与研究。     

美托洛尔对高血压左心室肥厚的影响

目的 观察美托洛尔对高血压左心室肥厚的影响。方法 选择门诊或住院病人,单纯性高血压同时合并有左心室肥厚238例,随机分为:①美托洛尔组120例,给予美托洛尔25-100mg/d;②硝苯地平组118例,给予硝苯地平20-60mg/d,疗程为6个月,采用惠普CF100彩色多普勒进行心脏形态学检查,作为评价指标。结果 美托洛尔组左心室后壁厚度及左心室重量指数较治疗前显著降低,P<0.01。结论 美托洛尔可以逆转高血压病程中的左心室肥厚。     

高血压患者左室构型改变与心功能的关系

目的探讨高血压患者左心室构型改变对心功能的影响。方法对高血压组164例和正常对照组30名进行常规心脏超声、心脏收缩功能和舒张功能检查。按Gnanu分类法将高血压组划分为正常构型组、向心性重构组、向心性肥厚组和离心性肥厚组。结果 E/A值在正常构型、向心性重构组、向心性肥厚组依次降低,在离心性肥厚组反而增高,舒张早期减速度(EDT)、等容舒张时间(IVRT)在高血压各组无统计学意义(P0.05);左心室短轴缩短率(FS)、左室射血分数(EF)在离心性肥厚组降低;心搏量(SV)、心输出量(CO)在正常构型、向心性重构组中无明显变化,而向心性重构组稍降低,离心性肥厚组稍增加;高血压各组Tei指数较正常对照组增高,在正常构型、向心性重构组、向心性肥厚组和离心性肥厚组呈依次增高,离心性肥厚组的Tei指数最高。结论高血压不同左室构型可引起左室收缩、舒张功能不同程度损害,以舒张功能障碍先于收缩功能障碍。而收缩功能受损以离心性肥厚组为明显。临床上应有效控制其构型的发展可从根本上减少心血管事件的发生率和病死率。     

佩尔地平抗高血压疗效及其对左室肥厚逆转的效应

为了探讨佩尔地平抗高血压（EH）疗效及其对左室肥厚逆转的效应，观察了31例EH患者服用佩尔地平治疗前后血压及左室肥厚的变化。结果显示：①佩尔地平治疗后，患者收缩压、舒张压和平均动脉压均明显降低，与治疗前比较有非常显著性差异（P＜0．01）。②佩尔地平治疗EH总有效率为93．6％，其中显效率为61．3％，有效率为32．3％。③服佩尔地平12周后，患者左室内径、舒张期空间隔厚度和左室后壁厚度均缩小；左室重量（LVM）和左室重量指数（LVMI）亦降低，与治疗前比较均有非常显著性差异（P＜0．01）。④佩尔地平对扩张性、对称性和不对称性左室肥厚的LVM和LVMI均有降低作用，与治疗前比较均有非常显著性差异（P＜0．01）。认为，佩尔地平不仅具有较好的降压效果，而且对不同类型的左室肥厚均有明显的逆转效应。     

The Effects of Simvastatin on Left Ventricular Hypertrophy and Left Ventricular Function in Patients with Essential Hypertension

This study is to evaluate the effects of Simvastatin on left ventricular hypertrophy and left ventricular function in patients with essential hypertension. Untreated or noncompliance with drug treatment patients with simple essential hypertension were treated with a therapy on the basis of using Telmisartan to decrease blood pressure (BP). There were 237 patients who had essential hypertension combined with left ventricular hypertrophy as diagnosed by echocardiography, taken after their BPs were decreased to meet the values of the standard normal. Among them, there were only 41 out of the original 237 patients, 17.3%, who had simple essential hypertension combined with left ventricular hypertrophy without any other co-existing disease. They were the patients selected for this study. All patients were randomly, indiscriminately divided into two groups: one was the control group (Group T), treated with the Telmisartan-based monotherapy; the other was the target group (Group TS), treated with the Telmisartan-based plus simvastatin therapy. The changes of left ventricular hypertrophy and left ventricular function were rediagnosed by echocardiography after 1 year. The results we obtained from this study were as follows: (i) The average BPs at the beginning of the study, of simple essential hypertension combined with left ventricular hypertrophy, were high levels (systolic blood pressure (SBP) 189.21 ± 19.91 mm Hg, diastolic blood pressure 101.40 ± 16.92 mm Hg). (ii) The Telmisartan-based plus simvastatin therapy was significantly effective in lowering the SBP (128.26 ± 9.33 mm Hg vs. 139.22 ± 16.34 mm Hg). (iii) After the 1-year treatment, the parameters of left ventricular hypertrophy in both groups were improved. Compared to group T, there were no differences in the characteristics of the subjects, including interventricular septum, left ventricular mass, left ventricular mass index, ejection fraction, left atrium inner diameter at baseline. The patients’ interventricular septum (Group TS 10.30 ± 1.80 mm vs. Group T 10.99 ± 1.68 mm, P < .05), LVM (Group TS 177.43 ± 65.40 g vs. Group T 181.28 ± 65.09 g, P < .05), and LVMI (Group TS 100.97 ± 37.33 g/m² vs. Group T 106.54 ± 27.95 g/m², P < .05), all dropped more prominently (P < .05) in group TS; the ejection fraction rose more remarkably in group TS (Group TS: 57.50 ± 16.41% to 65.43 ± 11.60%, P < .01 while showing no change in Group T); the left ventricular hypertrophy reversed more significantly and the left ventricular systolic function improved more. (iv) The left atrium inner diameter of Group TS decreased (P < .01), the ratio of E/A, which indicates the left ventricular diastolic function, continued to drop further, showing no change to the trend of left ventricular diastolic function declination. Patients who have hypertension with left ventricular hypertrophy usually suffer other accompanying diseases at the same time. Telmisartan-based plus Simvastatin treatment can significantly reduce SBP, reverse left ventricular hypertrophy, improve the left ventricular systolic function, but it has no effect on reversing the left ventricular diastolic function. This experiment indicated that Simvastatin can reverse left ventricular hypertrophy and improve left systolic function.     

二维多普勒超声对中年和老年人高血压性左室肥厚的比较研究

应用二维多普勒超声对36例中年和54例老年人的高血压性在室肥厚（LVH）及心功能状态进行分析比较。结果：中年组LVH类型：不对称性室间隔肥厚(ASH）占40%,对称性肥厚（CH）46％。扩张性肥厚（DH）占14％；老年组：ASH23%，CH26％，DH51％。将中年组和老年组分别同正常对照组比较，除中年组LVDd、LVV、EF及CO差异无显著性外，其余各指标差异均有显著性（P＜0.01或P＜0.O01）。中年组和老年组比较，E峰和A／E比值差异无显著性，其余各指标差异有显著性（P＜0.05或P＜0.O01）。结论认为在左室肥厚早期，左室充盈功能降低，左房增大，左房代偿性收缩增强，向左室泵血增多，以维持恒定的房室压差弥补左室充盈不足，左室收缩功能可表现为正常；在LVH晚期，失代偿后左室收缩及舒张功能均降低。     

美托洛尔逆转高血压性左心室肥厚的效应

观察368例高血压病患者美托洛尔治疗10周前后的血压、左室重量指数（LVMI）、左至壁平均厚度（MWTd）及心功能指标：左室对血分数（LVEF）、每博输出量（SV）、二尖瓣E／A峰速度比的变化。治疗后SBP、LVMI、PWTd比治疗前明显减少（P＜0．001）。SBP与LVMI呈正相关（r＝0．386）。心功能指标改善。提示美托洛尔降压的同时可使高血压性左心室肥厚逆转。     

苯那普利对高血压早期左室肥厚和左室舒张功能的影响

目的研究苯那普利对早期高血压心室肥厚和左心舒张功能的影响。方法血浆肾素活性、血管紧张素Ⅱ及醛固酮的含量在治疗前后被监测。左心室肌重及心舒张功能用彩色多普勒心动仪测定。结果经治疗３到４个月，血浆肾素、血管紧张素Ⅱ及醛固酮的含量降低。室间隔厚度（ＩＶＳＴ）、左室后壁厚度（ＬＶＰＷ）、左室质量（ＬＶＭ）缩小。心房收缩峰速（Ａ）和快速充盈峰速（Ｅ）之比降低。心室舒张平均速和峰速值增加。心室收缩功能指标如ＳＶ，ＥＦ和ＦＳ无变化。结论经苯那普利治疗后血压、心室质量及左心舒张功能指标有改善     

临界性高血压左心室肥厚、舒张功能及动态血压的初步探讨

目的：研究临界性高血压对左心室肥厚及左心室舒张功能的影响。方法：本文应用无创动态血压及二维彩色多普勒超声心动图检测方法对照研究９２例临界高血压患者左心室重量指数（ＬＶＭＩ）及舒张功能与血压水平及血压节律的关系。结果：临界性高血压组左心室肥厚发生率１８．５％，ＬＶＭＩ与对照组相比为１０７．２±１３．５ｇ比９２．５±１１．６ｇ（Ｐ＜０．０１），ＬＶＭＩ与昼间收缩压及昼间收缩压负荷值相关性最显著（ｒ分别为０．３０及０．２８，Ｐ＜０．０１），与２４小时收缩压及收缩压夜间昼间比值亦有较好的相关性（ｒ分别为０．２５及０．２２，Ｐ＜０．０５），临界性高血压组左心室舒张功能明显受损。结论：临界性高血压已不同程度的存在左心室结构及功能异常，收缩压水平及昼夜节律异常是左心室受累的主要因素。     

缬沙坦长期治疗对原发性高血压患者左心室肥厚及心功能影响的对比研究

目的探讨血管紧张素Ⅱ受体拮抗剂--缬沙坦对原发性高血压患者左心室肥厚及心功能的影响.方法入选经超声心动图检查证实为原发性高血压的左心室肥厚患者72例,随机分配到缬沙坦组(口服80～160mg/d)或阿替洛尔组(口服25～50 mg/d)(n均=36),治疗8个月,治疗前后各检查一次超声心动图及放射性核素心室显像,对比分析组内治疗前后左心室重量指数及左心功能参数变化和两组间的差异.结果①与治疗前比较,原发性高血压患者在缬沙坦或阿替洛尔治疗8个月后,两组收缩压与舒张压明显下降(159/101 mmHg至142/89 mmHg;161/103 mmHg至145/90mmHg,1 mmHg=0.133 kPa)(P均＜0.01).②原发性高血压患者在缬沙坦治疗8个月后,左心室后壁与室间隔厚度较治疗前显著下降(P均＜0.05),左心室重量及左心室重量指数下降更显著(P均＜0.01);而在阿替洛尔治疗8个月后左心室后壁与室间隔厚度无明显变化,左心室重量及左心室重量指数下降显著(P＜0.05).③原发性高血压患者在缬沙坦治疗8个月后左心室高峰充盈率明显增加(P＜0.05),而在阿替洛尔治疗8个月后左心室高峰充盈率无明显变化,两组间比较则有明显差别(P＜0.05).结论原发性高血压患者在缬沙坦治疗8个月后可使原发性高血压患者左心室肥厚显著逆转及左心室舒张功能显著改善,缬沙坦对左心室舒张功能的作用优于阿替洛尔.     

高血压左室肥厚病人的肾功能评价

目的研究高血压伴左室肥厚患者肾功能的改变。方法对３０例高血压伴左室肥厚病人及２１例年龄相当的健康人对照组行核素动态肾功能检测及彩色多普勒超声肾血流动力学检查,测定肾小球滤过率（ＧＦＲ）和肾脏指数（ＲＩ）及肾内动脉分布,段动脉、叶间动脉的阻力指数（ｒｉ）,血流峰速加速时间（ＡＴ）,收缩期最大血流速度（ＶＳ）,舒张期末最低血流速度（ＶＤ）。结果观察组肾内弓形动脉、小叶间动脉较对照组明显减少甚至不能显示,肾内段动脉和叶间动脉的阻力指数（ｒｉ）显著增加（Ｐ＜０．００１）,ＡＴ明显延长（Ｐ＜０．００１）,ＧＦＲ显著降低（Ｐ＜０．００１）,ＶＳ,ＶＤ及肾脏指数（ＲＩ）亦明显降低（Ｐ＜０．０１）。结论当临床血肌酐、尿素氮均正常时,高血压病伴左室肥厚的很多患者已经有肾功能的改变,早期检测和发现这种肾脏功能的改变有助于阻止高血压的进展和指导治疗     

Effects of Calcium Channel Antagonists on Left Ventricular Hypertrophy and Diastolic Function in Patients with Essential Hypertension

Hypertensive patients characteristically exhibit left ventricular (LV) hypertrophy and diastolic dysfunction. The effects of antihypertensive agents on LV hypertrophy and diastolic dysfunction do not always correlate with the degree of blood pressure reduction, but their effects on the sympathetic nervous system and renin–angiotensin system (RA system) are thought to be important. We investigated the effects of amlodipine and cilnidipine, N‐ and L‐type calcium channel antagonists that suppress both blood pressure elevation and sympathetic activities, on LV hypertrophy and diastolic function. Patients with essential hypertension were randomly assigned to receive either amlodipine, cilnidipine or nifedipine CR (which does not block N‐type calcium channels) for 6 months. The LV mass index was determined using M‐mode echocardiography. The E/A ratio, i.e., the ratio of maximum amplitude between the early diastolic wave (E wave) and the atrial systolic wave (A wave) in the LV inflow pattern, and the deceleration time for the E wave were determined using pulse Doppler echocardiography. Systolic and diastolic blood pressures significantly decreased from the baseline values in all three groups, with no significant differences among the groups. The LV mass index had significantly decreased when it was evaluated 3 months after the initiation of treatment in the cilnidipine group and when it was evaluated 6 months after the initiation of treatment in the amlodipine group; only a slight decrease was observed in the nifedipine CR group. A significant decrease in the deceleration time and a significant increase in the E/A ratio were observed after 3 months of treatment in the cilnidipine and amlodipine groups but not in the nifedipine CR group. Thus, the effects of long‐acting calcium channel antagonists on hypertensive LV hypertrophy and LV diastolic function varied from one antagonist to the other. Left ventricular hypertrophy and diastolic function improved in the cilnidipine and amlodipine groups, but not in the nifedipine CR group. These results indicate that the suppression of sympathetic nerve activity by the blockade of N‐type calcium channels contributes to the improvement of LV hypertrophy and diastolic function.     

Effects of Perindopril on Left Ventricular Hypertrophy and Heart Performance in Patients with Essential Hypertension

研究培哚普利对25例原发性高血压左室肥厚（LVH）的逆转效应及心功能的影响。疗程8周,剂量4～8mg,每日1次口服。结果显示,培哚普利降压疗效显著,LVH的逆转效应在短期（4周）治疗即可出现,8周后更为明显,左室重量指数（LV-MI）从143.2±21.3降至126.6±15.3g/m~2（P<0.001）,LV-MI降低主要由于空间隔及左室后壁厚度的减小所致,左室舒张末期内径无变化。左室收缩功能无变化,舒张功能（E/A）显著改善,E/A的增加百分率与LVMI的降低百分率呈正相关。研究表明,培哚普利每日1次口服短期可引起LVH的逆转伴有左室舒张功能的改善。