一平苏对维持性血透患者心血管保护作用的临床观察

观察一平苏对维持血透患者的心血管保护作用。方法：30例有高血压和左室肥厚并维持血透的患者随机分为两组，A组20例用一平苏2．5mg-5mg/d，B组给予不会影响左室重构的其它药作为对照。6个月后心脏多普勒超声检查左室重构及功能的情况。结果：两组虽均有明显降压，但一平苏组治疗后LVDd，IVS，LVPWD和LVMI均有统计学意义的下降，EF和E／A均明显升高。结论：一平苏不仅可安全有效地降压，这可逆转血透患者的左室肥厚及使左室功能改善。     

氯沙坦对高血压左心室肥厚的逆转作用

目的:评价氯沙坦对高血压左心室肥厚的逆转作用.方法:对52例高血压左心室肥厚的患者用氯沙坦50～100 mg治疗8～10周后进行观察.结果:氯沙坦治疗后血压平均下降29/12 mmHg±5/3 mmHg , 治疗后室间隔厚度 (IVST) 、心室后壁厚度(PWT)、左室重量指数(LVMI)均有明显减少(均为P<0.01),说明左室肥厚减轻,左室舒张功能得到改善.结论:氯沙坦能有确切降压效果,并有逆转左室肥厚的作用.     

苯那普利,安体舒通治疗高血压疗效及对左室肥厚、心功能的影响

目的: 观察安体舒通联合苯那普利及小剂量双克治疗高血压疗效及对左室肥厚、心功能影响.方法:76 例高血压并左室肥厚病人给予双克25 mg/d,苯那普利5～10 mg qd～bid,同时随机分为两组;治疗组:安体舒通60 mg qd.对照组:口服安慰剂, 疗程均为1年.治疗前及治疗6、12个月后观察:(1)动态血压;(2)超声心动测左室舒张末内径,左室后壁厚度,空间隔厚度,EF值及E/A比值,并计算左室重量,左室心脏重量指数;(3)对血钾、肾功、血糖,血脂影响.结果:两组均有明显降压作用;P<0.05, 治疗几个月后治疗组比对照组疗效更显著P<0.05, 且有显著逆转左室肥厚作用,治疗后LVDd、IVST、LVPWT、LV MW及LVMI 均明显降低,EF值、E/A均有明显升高P<0.05,治疗12月后,治疗组以上指标疗效优于对照组P<0.01,治疗前后对血钾、肾功、血糖、血脂均无显著影响P>0.05.结论:安体舒通联合苯那普利及低剂量双克降压,逆转左室肥厚,改善心功能疗效显著, 且不影响电解质及血糖,血脂代谢.     

氯沙坦或氨氯地平对老年高血压左室肥厚伴阵发性房颤的影响

目的 通过观察老年高血压左室肥厚患者心脏结构及功能的改变与阵发房颤的变化。探讨氯沙坦对老年高血压左室肥厚伴阵发房颤的影响。方法 选择83例老年高血压左室肥厚患者，随机分为二组：氯沙坦组43例。口服氯沙坦50-100mg／天；氨氯地平组加例，口服氨氯地平5—10mmg／d，治疗12-17个月。分别测定治疗前后阵发房颤的变化及左房内径与左室结构及功能的变化。结果 与治疗前比，氯沙坦组及氨氯地平组左室重量指数（LVM1）均明显减少（均P〈0.05），E／A较治疗前增加，即等容舒张时间较治疗前缩短（均P〈0．05）。说明左室舒张功能均得到改善，左房内径较治疗前减小（均P〈0．05），动态心电图中阵发房颤较治疗前减少（78．5％、14．3％）。结论 氯沙坦在有效降压的同时，既可有效改善左房的结构重构及电重构，又可逆转左室肥厚，改善左室舒张功能，降低左房压力，减小左房内径，减少阵发房颤的发生。     

氯沙坦联用葛根素对原发性高血压左心室肥厚的逆转及胰岛素抵抗的影响

目的观察氯沙坦单用或联用葛根素对原发性高血压并左室肥厚(LVH)的逆转作用及其对胰岛素抵抗的影响.方法 60例原发性高血压并左室肥厚病人随机分成两组:对照组(A组)30例口服氯沙坦,每日50 mg;治疗组(B组)30例给予氯沙坦,每日50 mg,加葛根素注射液500 mg.两组均持续治疗4周.观察左室形态结构和左室功能变化及其对胰岛素抵抗的影响.结果两组治疗后,血压水平降低,室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室舒张末期内径(LVDd)、左室重量(LVMI)均显著下降(P<0.05或P<0.01),特别是B组在逆转LVH方面效果优佳(P<0.05).与A组比较,B组治疗后2 h血糖和空腹胰岛素明显降低,而胰岛素敏感性指数明显升高.结论氯沙坦联用葛根素治疗原发性高血压,既可有效降压,又可逆转LVH以及改善胰岛素抵抗.     

氨氯地平联合替米沙坦及复方盐酸阿米洛利治疗高血压和左室肥厚的效果及其与瘦素的关系

目的 比较氨氯地平联合应用替米沙坦（氨+替组）及氨氯地平联合应用复方盐酸阿米洛利（氨+阿组）对高血压患者血压及左室肥厚（LVH）的影响,并探讨血压和左室肥厚与血清瘦素水平的关系。方法 将确诊的92例LVH患者随机分配到氨+替组（46例）和氨+阿组（46例）。治疗半年后,观察两组患者心脏形态学、心脏功能及血清瘦素水平的变化。结果 氨+替组及氨+阿组患者经过治疗后,收缩压、舒张压、室间隔厚度、左室质量、左室质量指数及血清瘦素水平与治疗前比较,均有显著降低（均P<0.01）,E/A比值及EF值与治疗前比较有显著增高（P<0.05）,但两组间治疗后收缩压、舒张压差别无统计学意义,余均有显著改变（P<0.05）,氨+替组作用更明显。结论 氨+替组有更好的降压、保护心脏的效果。瘦素参与了左心室肥厚的发生、发展,可作为观察高血压患者病情变化的指标。     

苯那普利,安体舒通治疗高血压疗效及对左室肥厚、心功能的影响

目的 :观察安体舒通联合苯那普利及小剂量双克治疗高血压疗效及对左室肥厚、心功能影响。方法 :76例高血压并左室肥厚病人给予双克 2 5 mg/d,苯那普利 5～ 10 mg qd～ bid,同时随机分为两组 ;治疗组 :安体舒通6 0 m g qd。对照组 :口服安慰剂 ,疗程均为 1年。治疗前及治疗6、12个月后观察 :(1)动态血压 ;(2 )超声心动测左室舒张末内径 ,左室后壁厚度 ,空间隔厚度 ,EF值及 E/A比值 ,并计算左室重量 ,左室心脏重量指数 ;(3)对血钾、肾功、血糖 ,血脂影响。结果 :两组均有明显降压作用 ;P<0 .0 5 ,治疗几个月后治疗组比对照组疗效更显著 P<0 .0 5 ,且有显著逆转左室肥厚作用 ,治疗后 L VDd、IVST、L VPWT、L V MW及 L VMI均明显降低 ,EF值、E/A均有明显升高 P<0 .0 5 ,治疗 12月后 ,治疗组以上指标疗效优于对照组 P<0 .0 1,治疗前后对血钾、肾功、血糖、血脂均无显著影响 P>0 .0 5。结论 :安体舒通联合苯那普利及低剂量双克降压 ,逆转左室肥厚 ,改善心功能疗效显著 ,且不影响电解质及血糖 ,血脂代谢     

长期应用依那普利对高血压病患者左室结构及功能影响

观察了28例Ⅱ期高血压病患者平均口服依那普利平均22个月后左室结构及功能改变。结果显示：用药后血压降低总有效率为89．3％，心率无变化。用药后空间隔、左室后壁及左定重量指数均明显下降（P＜0．05），A峰速度及A／E比值明显下降，E峰速度明显增高（P＜0．05）。提示：依那曾利长期治疗可有效降压，并同时逆转左室肥厚，改善左室舒张功能。     

北京降压0号和吲哒帕胺对左室肥厚的逆转作用

目的采用动态血压监测的方法比较北京降压0号与吲哒帕胺治疗轻中度原发性高血压的疗效和谷峰比值(T/P),平滑指数(SI),对左室肥厚(LVH)逆转情况。方法服用安慰剂2周后的轻中度原发性高血压并经二维超声心动图确诊有LVH的患者60例,随机分为两组,北京降压0号组1～2片/d,吲哒帕胺组2.5～5mg/d共24周,比较治疗前及治疗24周后坐位血压、动态血压(ABP)、左室质量指数(LVMI)的影响,并进行T/P、SI的计算。结果降压0号组收缩压(SBP)谷峰比77.5%,SBP的SI为4.11,吲哒帕胺组SBP谷峰比74.0%,SBP的SI为3.97,两组SI及T/P比较差异无显著意义。治疗后两组室间隔厚度、左室后壁厚度、左室心肌质量量指数明显减少,P<0.05。结论服北京降压0号1次/d,与吲哒帕胺长期治疗后均有明显降低血压,并维持24h疗效,而且能够明显逆转LVH,改善左室舒张功能。     

北京降压0号和吲哒帕胺对左室肥厚的逆转作用

目的 采用动态血压监测的方法比较北京降压0号与吲哒帕胺治疗轻中度原发性高血压的疗效和谷峰比值(T/P),平滑指数(SI),对左室肥厚(LVH)逆转情况.方法 服用安慰剂2周后的轻中度原发性高血压并经二维超声心动图确诊有LVH的患者60例,随机分为两组,北京降压0号组1～2 片/d,吲哒帕胺组2.5～5 mg/d共24周,比较治疗前及治疗24周后坐位血压、动态血压(ABP)、左室质量指数(LVMI)的影响,并进行T/P、SI的计算.结果 降压0号组收缩压(SBP)谷峰比77.5%,SBP的SI为4.11,吲哒帕胺组SBP谷峰比74.0%,SBP的SI为3.97,两组SI及T/P比较差异无显著意义.治疗后两组室间隔厚度、左室后壁厚度、左室心肌质量量指数明显减少,P＜0. 05.结论 服北京降压0号1次/d,与吲哒帕胺长期治疗后均有明显降低血压,并维持24 h疗效,而且能够明显逆转LVH,改善左室舒张功能.     

氯沙坦与西拉普利对充血性心力衰竭的疗效比较

目的：比较氯沙坦与西拉普利对充血性心力衰竭(CHF)的临床疗效及安全性。方法：54例CHF患者在常规治疗基础上随机分为两组。氯沙坦组(27例)用氯沙坦50mg／d；西拉普利组(27例)用西拉普利2．5mg／d。治疗前与治疗后6个月分别用超声心动图测量左室射血分数(LVEF)、左室短轴缩短分数(LVFS)、每搏输出量(SV)、心排量(CO)、心脏指数(CI)评估心功能。结果：治疗6个月后，两组心功能较治疗前明显改善(P＜0．01)，两组之间比较无显著性差异(P＞0．05)。结论：氯沙坦与西拉普利治疗CHF均是安全有效的。     

Relative wall thickness is an independent predictor of left ventricular systolic and diastolic dysfunctions in essential hypertension.

The objective of this study was to elucidate the relationship between left ventricular geometry and left ventricular (LV) function in patients with untreated essential hypertension. We evaluated LV systolic and diastolic functions by M-mode echocardiography in 24 normotensive control subjects (NC) and 129 patients with essential hypertension. Patients were divided into four groups according to the relative wall thickness and LV mass index: a normal left ventricle (n=57), a concentric remodeling (n=7), a concentric hypertrophy (n=31), and an eccentric hypertrophy (n=34) group. LV systolic function as measured by midwall fractional shortening (FS) was significantly decreased in both the concentric remodeling and concentric hypertrophy groups; no differences were observed for endocardial FS. LV diastolic function as measured by isovolumic relaxation time (IRT) was also decreased in both the concentric remodeling and concentric hypertrophy groups. In multivariate analysis, relative wall thickness (p<0.0001), end-systolic wall stress (p<0.0001), and systolic blood pressure (p=0.002) were independently associated (r2=0.72) with midwall FS in a model including age, LV mass index, body mass index, diastolic blood pressure and IRT. In addition, relative wall thickness (p=0.0008) and age (p<0.0001) were independently associated (r2=0.31) with IRT in a model including LV mass index, end-systolic wall stress, body mass index, systolic and diastolic blood pressures and midwall FS. We conclude that LV geometry as evaluated by relative wall thickness may provide a further independent stratification of LV systolic and diastolic functions in essential hypertension.     

原发性高血压患者血清Ⅰ型和Ⅲ型前胶原水平及药物干预研究

目的　测定血清 型和 型前胶原 (procollagen,PC)水平 ,评价高血压患者心肌纤维化程度 ,并分析使用抑平舒 (Cilazapril)或波依定 (Felodipine)抗高血压治疗对二者的影响。方法　 4 9例原发性高血压患者分为两组 :抑平舒治疗组 (n=2 2 )和波依定治疗组 (n=2 7) ,2 3例未经治疗的高血压患者作为实验对照组 ,2 0名同龄健康者为正常对照组 ,采用放射免疫分析法测定其血清 PC 、PC 水平 ,用超声测量其左心室解剖参数 ,计算左心室质量指数(L VMI)。结果　高血压实验对照组 L VMI、血清 PC 、PC 水平较正常对照组显著升高 (L VMI:110 .0 7± 19.31对 83.73± 15 .5 0 ,PC :12 0 .96± 2 4 .4 2对 71.6 3± 17.80 ,PC :95 .92± 9.75对 6 7.90± 9.37,P<0 .0 1)。高血压患者中未经治疗者 L VMI、血清 PCI水平显著高于经抑平舒或波依定治疗 6个月的患者 (L VMI:110 .0 7± 19.31对 96 .95± 2 1.92 ,110 .0 7± 19.31对 98.5 1± 19.2 5 ;PC :12 0 .96± 2 4 .4 2对 80 .5 1± 19.6 6 ,12 0 .96± 2 4 .4 2对93.0 5± 19.6 1,P<0 .0 1) ,血清 PCI水平抑平舒治疗组低于波依定治疗组 (80 .5 1± 19.6 6对 93.0 5± 19.6 1,P<0 .0 5 ) ,而血清 PC 水平高血压患者三组间均无差异。结论　 1.血清 PC 和 PC 浓度可以?     

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。     

氯沙坦对老年高血压病患者左室功能改善的临床观察

目的 观察氯沙坦对老年高血压左室肥厚病人左室舒张的影响。方法 对43例老年高血压左室肥厚患者口服氯沙坦（50－100mg/d）治疗12－17个月,应用平稳法放射性核素心室造影,观察其治疗前后左室舒张功能改善情况。结果 治疗后较治疗前左室舒张功能得到明显改善（P＜0．05）。结论 氯沙坦在有效降压的同时,明显改善左室舒张功能。     

心率变异性与高血压左室重构关系的研究

目的：心率变异性（ＨＲＶ）分析是反映心脏自主神经活动的一项无创性指标。方法：研究ＨＲＶ在高血压左室重构中的作用,应用ＨＲＶ时域与频域分析法,检测与分析７０例高血压病（ＥＨ）男性患者２４小时ＲＲ间期标准差（ＳＤＮＮ）、心率变异指数（ＨＲＶＩ）及心率功率谱密度（ＰＳＤ）;并采用超声心动图测定相对室壁厚度（ＲＷＴ）与左室重量指数（ＬＶＭＩ）对患者进行左室构型分类。３０例健康男性被同期检测,以作对照。结果：７０ 例ＥＨ 患者被分为正常构型（ＲＷＴ 与ＬＶＭＩ均正常）,向心性重构（ＲＷＴ 增加,但ＬＶＭＩ正常）,向心性肥厚（ＲＷＴ与ＬＶＭＩ均增加）及离心性肥厚（ＲＷＴ正常,但ＬＶＭＩ增加）四个左室构型组。四组患者ＳＤＮＮ、ＨＲＶＩ、ＰＳＤ的低频（ＬＦ）峰值及其与高频（ＨＦ）峰值之比（ＬＦ／ＨＦ）均较正常人减低,而ＰＳＤ的ＨＦ峰值却均较正常人增高,该ＨＲＶ 变化特征的显著性依上述左室构型顺序呈现进行性增强。结论：交感与副交感神经的双重损害参与了高血压的左室重构机制,且其损害程度可能伴随左室重构过程的进行而加重     

The acute and chronic effects of cilazapril on cardiac function in hypertensive patients

The effect of cilazapril, 2.5 to 5.0 mg on systolic and diastolic cardiac function was studied by echocardiography and radionuclide ventriculography, in 15 hypertensive patients. The measurements were made before and 3 hours after the first dose, and after 10 weeks of treatment. Cilazapril lowered the elevated blood pressure and did not affect the normal ejection fraction. An improvement in indices of diastolic function was observed after the first dose. The normalized peak filling rate significantly increased from 2.4 +/- 0.7 to 2.7 +/- 0.7 counts and time to peak filling rate was shortened from 169.4 +/- 31.0 to 151.6 +/- 40.1 msec. This improvement was sustained or even enhanced during chronic therapy. Long-term treatment with cilazapril, caused regression of left ventricular hypertrophy. In conclusion: cilazapril improves diastolic cardiac function in hypertensive patients. The beneficial effect may be partially related to regression of left ventricular hypertrophy.     

Comparative evaluation of the effect of afterload- and preload-reducing drugs on diastolic cardiac function in hypertensive patients

The effects of cilazapril, isosorbide-5-mononitrate (ISMN), hydrochlorothiazide and placebo on systolic and diastolic cardiac function were studied to evaluate the relative importance of afterload and preload reduction on cardiac function in hypertensive patients. In 86 patients with essential hypertension, radionuclide studies were performed before and after a single oral dose of placebo (18 patients), cilazapril 2.5 mg (35 patients), ISMN 20 mg (18 patients) or hydrochlorothiazide 25 mg (15 patients). The effects on blood pressure, heart rate, left ventricular ejection fraction, peak filling rate and time to peak filling rate were measured. Placebo had no significant effect. A comparable blood-pressure-lowering effect was achieved with cilazapril and hydrochlorothiazide. Cilazapril improved diastolic function by increasing the normalized peak filling rate from 2.3 +/- 0.7 to 2.7 +/- 0.7 vol/s (p less than 0.05) and reducing the time to PFR from 174.5 +/- 33.6 to 152.4 +/- 30.8 ms (p less than 0.005). Hydrochlorothiazide and ISMN, however, impaired left ventricular diastolic function: hydrochlorothiazide decreased the normalized peak flow rate from 2.2 +/- 0.6 to 1.9 +/- 0.6 vol/s (p less than 0.05). ISMN prolonged the time to peak flow rate from 176 +/- 36 to 195 +/- 29 ms and increased the percentage of diastole to peak flow rate from 46 to 53% (p less than 0.05), whereas the normalized peak flow rate was unaltered. In conclusion, predominant afterload reduction by cilazapril improves left ventricular diastolic function in hypertensive patients, while preload reduction by diuretics and nitrates impairs it.     

老年高血压病患者24 h 动态脉压与左室结构及功能变化的相关性研究

目的探讨老年高血压病患者24h动态脉压（24hPP）与左室结构及功能变化的相关性。方法对145例老年高血压病患者进行动态血压监测和超声心动图检查。将24hPP≥60mmHg的患者88例列为A组,24hPP〈60mmHg的患者57例列为B组,分别测量两组患者室间隔厚度（IVST）、左室后壁厚度（LVPWT）、左室舒张末期内径（LVEDD）,计算左室质量指数（LVMI）、左室射血分数（LVEF）及E／A,进行对比分析。结果A组患者LVMI及影响LVMI的3大因素（IVST,LVPWT,LVEDD）均明显高于B组（均P〈0．01）,显示随着脉压增大,出现明显的左心室肥厚;三型肥厚组患者的24hPP均高于无肥厚组;以扩张性肥厚组最显著。A组患者EF及E／A均低于B组,显示随着脉压增大,左室收缩舒张功能减退,以舒张功能受损更显著（P〈0．01）。结论24hPP增高是老年高血压病患者左室肥厚及心功能减退的重要危险因素。     

The effect of cilazapril on systolic and diastolic cardiac function in hypertensive patients

Diastolic function may be impaired in hypertensives even before alterations occur in systolic function. We studied the effect of a single dose of cilazapril, 5 mg orally, on systolic and diastolic cardiac function in 20 hypertensive patients using a double-blind crossover placebo controlled design. All patients had mild to moderate concentric left ventricular hypertrophy, preserved systolic function and long standing hypertension (for a period of 11.9 +/- 9.0 years). Radionuclide scintigraphy was performed with cilazapril and placebo, given one week apart. A two-week washout period of all cardioactive drugs preceded the study. Within one hour of oral administration of cilazapril blood pressure was significantly lowered. The absolute time to peak filling rate of the left ventricle, as well as the time to peak filling rate expressed as a percentage of diastole, were reduced from 176 +/- 34 to 158 +/- 33 msec (P less than 0.01) and from 46 +/- 10% to 37 +/- 8% (P less than 0.02) (reduction by 9% and 18.4%, respectively). Heart rate, left and right ventricular ejection fraction and peak filling rate was not significantly altered. Placebo had no significant effect. The effect of cilazapril is most probably related to afterload reduction. In conclusion; cilazapril seems to improve diastolic cardiac function in hypertensive patients. Long-term therapy may result in improvement of other, less sensitive indices of diastolic dysfunction.