伊贝沙坦抗高血压及逆转左心室肥厚的作用

目的　观察伊贝沙坦降压疗效及其对原发性高血压 ( EH)左心室肥厚 ( L VH)的逆转作用。方法　 5 6例患者口服伊贝沙坦15 0～ 30 0 mg/d,治疗 8周 ,比较治疗前后 2 4h动态血压及左心室重量指数 ( LVMI)。结果　伊贝沙坦可使患者 2 4h平稳降压 ,L V-MI较治疗前减低 ( P<0 .0 1)。结论　伊贝沙坦能有效控制血压 ,对 EH的 LVH有逆转作用。     

伊贝沙坦对轻、中度高血压患者hsCRP水平的影响

对轻、中度高血压患者分别予口服伊贝沙坦和吲达帕胺治疗3个月,测定治疗前后两组血压和血清高敏感性C反应蛋白(hsCRP)水平。结果发现,治疗前所有患者收缩压、舒张压和脉压差与血清hsCRP水平相关系数分别为0.136、0.093和0.237,P均<0.05。伊贝沙坦组和吲达帕胺组治疗后血压水平相比无显著性差异;血清hsCRP水平分别为(1.21±0.41)和(1.50±0.56)m g/L,两者相比差异显著,P<0.05。提示轻、中度高血压患者血压水平与血清hsCRP水平呈正相关,伊贝沙坦能降低轻、中度高血压患者的血清hsCRP水平,这种作用部分不依赖于其降压作用。     

吲达帕胺与非洛地平或苯那普利联合治疗老年高血压病的观察

目的 观察吲达帕胺和非洛地平联合与吲达帕胺和苯那普利联合治疗老年原发性高血压患者的降压疗效及不良反应。方法 根据1999年WHO标准选取老年原发性高血压病例，分为A组(吲达帕胺2．5mg，非洛地平5mg，每日一次，53例)，B组(吲达帕胺2．5mg，苯那普利10mg，每日1次，53例)；由固定医生每周随访1次，测坐位血压，于服药前、服药后4w、8w、12w检查血糖、血脂、电解质、心电图、肝功能、肾功能。结果 两组药物对老年原发性高血压均有明显疗效（P＜0．01)，总有效率两组无明显差异(P＞0．05)。在降压幅度中，两组对DBP的降低无明显差别(P＞0．05)。两组对SBP和PP的降低则B组优于A组(P＜0．05)。两组仅有轻微的不良反应，均不需停药。结论 吲达帕胺分别与非洛地平及苯那普利联合是治疗老年原发性高血压的理想联合方案，对SBP和PP控制方面以吲达帕胺与苯那普利联合更佳，且能抵消影响血钾的副作用．     

伊贝沙坦联合吲哒帕胺对原发性高血压的疗效及左心室肥厚的逆转作用

目的:观察伊贝沙坦与吲哒帕胺联用的降压疗效及对原发性高血压(EH)左心室肥厚(LVH)的逆转作用.方法:将82例EH伴LVH患者随机分为A组(单用伊贝沙坦)40例,B组(伊贝沙坦与吲哒帕胺联用)42例.观察2组治疗前后及2组间血压及LVH指标的变化.结果:6个月后2组血压均较治疗前明显下降(P＜0.01),组间降压幅度差异无统计学意义,2组左心室质量指数均较治疗前明显降低(P＜0.05或P＜0.01),B组较A组更明显(P＜0.05).结论:伊贝沙坦联合吲哒帕胺能有效地控制血压且对EH的LVH有逆转作用.     

吲达帕胺治疗老年单纯收缩期高血压疗效及其对代谢的影响

目的 :探讨吲达帕胺对老年单纯收缩期高血压 (ISH)的疗效及其对代谢的影响。方法 :10 2例老年ISH患者随机分为吲达帕胺治疗组 (n =5 2 ,吲达帕胺 1.2 5～ 2 .5mg/d)和非洛地平治疗组 (n =5 0 ,非洛地平 5～ 15mg/d)。每 1～ 2周测量坐位血压 1次。治疗前和治疗后 2个月后分别检测空腹血糖 ,血脂 ,血尿酸 ,血肌酐 ,血钾、钠和氯。结果 :两组治疗前后降压疗效差异均有非常显著性意义 (P <0 .0 1) ,但组间相比差异无显著性意义 (P 0 .0 5 )。两组治疗前后空腹血糖 ,血脂 ,血尿酸 ,血肌酐 ,血钾、钠和氯亦无统计学差异。结论 :吲达帕胺治疗老年ISH安全、有效 ,对空腹血糖 ,血脂 ,血尿酸 ,血肌酐 ,血钾、钠和氯无明显不良影响 ,是治疗老年ISH的第一线药物     

厄贝沙坦对老年原发性高血压患者降压和逆转左心室肥厚的作用

目的观察厄贝沙坦对老年原发性高血压患者降压和逆转左心室肥厚（LVH）的作用。方法对85例老年原发性高血压合并LVH患者采用厄贝沙坦治疗,观察治疗前后血压、心率及超声心动图的变化情况。结果与治疗前比较,治疗后收缩压、舒张压下降（P均〈0．05）;室间隔厚度、左心室后壁厚度、左心室舒张末期内径、左心室质量指数降低（P均〈0．05）,心率无明显变化（P〉0．05）。结论厄贝沙坦能逆转原发性高血压引起的LVH并改善左心室舒张功能,明显改善老年原发性高血压患者预后。     

厄贝沙坦联合吲达帕胺治疗高血压合并糖尿病的效果评价

目的研究厄贝沙坦联合吲达帕胺治疗高血压合并糖尿病患者的效果。方法选取我院2017年10月至2018年9月收治的84例高血压合并糖尿病患者作为研究对象,按照随机数字表法分为对照组(42例)与观察组(42例),对照组采用吲达帕胺单药治疗,观察组采用厄贝沙坦联合吲达帕胺治疗。将两组高血压合并糖尿病患者的血压水平、尿微量白蛋白水平、肾功能指标进行比对。结果观察组高血压合并糖尿病患者治疗后的舒张压、收缩压均明显低于对照组数据,差异具有统计学意义(P0.05);观察组高血压合并糖尿病患者治疗后的BUN、Scr、mAlb水平均低于对照组,差异具有统计学意义(P0.05)。结论高血压合并糖尿病患者采用厄贝沙坦与吲达帕胺联合用药方案取得的疗效确切,患者的血压水平控制良好,肾功能得到了有效改善,具有较高的临床推广应用价值。     

吲达帕胺治疗原发性高血压的疗效观察

吲达帕胺 (indapam ide)是 90年代提倡使用的降压药。应用吲达帕胺治疗 45例原发性高血压 (EH)患者 ,取得较好疗效。1　对象和方法1.1　对象　 EH患者 45 (男 2 5 ,女 2 0 )例 ,年龄 40～ 75岁。均符合 1999年 WHO/ ISH对高血压水平的定义和分级 ,即血压≥ 140 / 90 mm Hg(1mm Hg=0 .133k Pa) ,其中 级 11例 , 级 2 5例 , 级 9例 ,且排除继发性高血压。1.2　方法　吲达帕胺 (天津力生制药厂 ) 2 .5 m g,每日 1次 ,2周后血压控制不满意者剂量加倍 ,连服 4周 ,治疗期间住院患者每天测血压 2次 ,门诊患者每周测血压 2次 ,同时观察副作用…     

不同联合用药对老年单纯收缩期高血压患者大动脉僵硬度的疗效比较

目的探讨基于利尿剂、钙拮抗剂的不同联合用药对老年单纯收缩期高血压(ISH)患者血压、靶器官损害和大动脉僵硬度的影响。方法将最终完成试验的ISH患者95例分为4组,A组24例(吲达帕胺+苯磺酸氨氯地平);B组24例(吲达帕胺+苯磺酸氨氯地平+阿托伐他汀钙);C组23例(吲达帕胺+苯磺酸氨氯地平+马来酸依那普利);D组24例(吲达帕胺+苯磺酸氨氯地平+螺内酯);以24h动态血压判定降压疗效;以肱踝脉搏波传导速度(baPWV)作为动脉硬化指标;以室间隔、左心室后壁厚度及左心室质量作为靶器官损害指标。结果 4组治疗后较治疗前24h收缩压、舒张压、脉压均明显降低(P0.01);baPWV明显减慢(P0.01);C组较A、B和D组baPWV和舒张末左心室后壁厚度[(9.7±4.4)mmvs(10.5±4.0)mm、(10.7±4.5)mm和(10.3±4.7)mm,P=0.006]改变明显。结论老年ISH的治疗不仅要降低血压,而且应减少大动脉僵硬度。     

比索洛尔对高血压左室肥厚与血压昼夜节律异常的影响

目的 :观察高血压左室肥厚 (LVH)与血压昼夜节律关系及比索洛尔对其影响。方法 :4 5例原发性高血压 (EH)伴LVH患者服药前行动态血压及超声心动图检测 ,并于服药后 8周进行复查比较。结果 :血压昼夜节律消失组 30例 ,血压昼夜节律正常组 15例。血压昼夜节律消失组 2 4h收缩压、夜间血压、血压负荷均高于血压昼夜节律正常组。昼夜节律消失组服用比索洛尔 8周后 ,昼夜节律、室间隔厚度、左室后壁厚度、左室重量指数、舒张晚期血流峰速、等容舒张时间均有明显改善 ,血压昼夜节律正常组左室功能也有改善。结论 :高血压LVH患者血压昼夜节律消失多见 ,索他洛尔可使血压昼夜节律趋于正常 ,可使左室功能改善     

Perindopril/indapamide combination more effective than enalapril in reducing blood pressure and left ventricular mass: the PICXEL study

OBJECTIVE: Few data are available comparing the effects of monotherapy and combination therapy on target organ damage. The PICXEL study compared the efficacy of a strategy based on first-line combination with perindopril/indapamide versus monotherapy with enalapril in reducing left ventricular hypertrophy (LVH) in hypertensive patients. METHODS: In this 1-year multicentre randomized double-blind study, patients received an increasing dosage of perindopril/indapamide (n = 284) or enalapril (n = 272). Changes in blood pressure and echocardiographic measures of LVH were assessed from baseline to the end of treatment. Reading of the echocardiograms was central and blinded for therapy, patient and sequence. RESULTS: Systolic and diastolic blood pressure decreased significantly more in the perindopril/indapamide than in the enalapril group (P < 0.0001 and P = 0.003). The left ventricular mass index decreased by 13.6 +/- 23.9 g/m(2) (mean +/- SD) with perindopril/indapamide (P < 0.0001) and 3.9 +/- 23.9 g/m(2) with enalapril (P < 0.005); these decreases were significantly different (P < 0.0001). The left ventricular internal diameter, posterior and interventricular septal wall thickness decreased significantly with perindopril/indapamide (P < or = 0.0001); the interventricular septal wall thickness decreased significantly with enalapril (P < 0.001). Both treatments were well tolerated. CONCLUSION: A strategy based on first-line combination with perindopril/indapamide achieved better blood pressure decrease with a significantly greater degree of LVH reduction than a strategy based on monotherapy with enalapril in hypertensive patients with LVH.     

Myocardial fibrosis and diastolic dysfunction in patients with hypertension: results from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol (SILVHIA)

OBJECTIVES: Hypertensive left ventricular hypertrophy (LVH) is associated with cardiomyocyte hypertrophy and an excess in myocardial collagen. Myocardial fibrosis may cause diastolic dysfunction and heart failure. Circulating levels of the carboxy-terminal propeptide of procollagen type I (PICP), an index of collagen type I synthesis, correlate with the extent of myocardial fibrosis. This study examines myocardial fibrosis in relation to blood pressure, left ventricular mass (LVM), and diastolic function. METHODS: We examined PICP levels in 115 patients with hypertensive LVH, 38 with hypertension but no hypertrophy, and 38 normotensive subjects. Patients with LVH were subsequently randomly assigned to the angiotensin II type 1 receptor blocker irbesartan or the beta1 receptor blocker atenolol for 48 weeks. Diastolic function was evaluated by tissue velocity echocardiography (n=134). We measured basal septal wall velocities of early (Em) and late (Am) diastolic myocardial wall motion, Em velocity deceleration time (E-decm), and isovolumic relaxation time (IVRTm). RESULTS: Compared with the normotensive group, PICP was elevated and left ventricular diastolic function was impaired in the hypertensive groups, with little difference between patients with and without LVH. PICP related to blood pressure, IVRTm, Em, and E/Em, but not to LVM. Irbesartan and atenolol reduced PICP similarly. Only in the irbesartan group did changes in PICP relate to changes in IVRTm, and LVM. CONCLUSION: Myocardial fibrosis and diastolic dysfunction are present in hypertension before LVH develops. The findings with irbesartan suggest a role for angiotensin II in the control of myocardial fibrosis and diastolic function in patients with hypertension with LVH.     

高血压病患者动态血压对左室肥厚及颈动脉内-中膜厚度的影响

目的：探讨高血压病患者动态血压参数与左室肥厚及颈动脉内-中膜厚度的影响。方法：初诊的高血压病患者125例经超声心动图和颈动脉超声检查被分为颈动脉内-中膜增厚组（n=44例）和无内-中膜增厚组（n=81例）；左室肥厚组（n=37例）和无左室肥厚组（n=88例）。测定动态血压参数，血脂、血糖等生化指标，并进行比较。结果：（1）左室肥厚组与无左室肥厚组的临床指标比较差异不显著（P〉0．05）；（2）左室肥厚组与无左室肥厚组的动态血压参数比较分别为：24h平均收缩压（141．5±13．7）：（127．5±11．9）mmHg，24h平均舒张压（87．1±8．6）：（80．9±9．1）mmHg，24h脉压（53．9±10．3）：（44．9±9．5）mmHg，动态血压非勺型昼夜节律60．3％：28．7％，其差异均有显著性（P均〈0．05）；（3）颈动脉内-中膜增厚组与无内-中膜增厚组的上述临床指标比较，差异不显著（P〉0．05），而动态血压参数比较差异有显著性（P〈0．05）。结论：高血压病动态血压参数对左室肥厚及颈动脉内-中膜增厚有显著影响，可能参与其发病机制。     

Indapamide regresses,but transdermal clonidine does not regress,left ventricular hypertrophy in hypertensive diabetic patients

This report describes the effects of indapamide versus transdermal clonidine on left ventricular hypertrophy (LVH) in hypertensive diabetic patients. A sample of 24 hypertensive diabetic men, aged 40–68 years, with echocardiographically proven LVH was equally divided into 2 groups. Group I was treated with indapamide 2.5 mg/day, and group C with transdermal clonidine weekly. Left ventricular mass and posterior wall and septal thickness were measured by standard echocardiograms done at baseline and every 6 months. At 24 months, treatment crossover was done. Normotension was maintained throughout the study. With indapamide, LVH regression was measurable at 6 months, and left ventricular mass had returned to normal after 18 months. Transdermal clonidine did not regress LVH, but when the patients were switched to indapamide, LVH did regress. Clonidine maintained normal ventricular dimensions after regression had been induced by indapamide.     

血管紧张素Ⅱ水平与原发性高血压左心室肥厚的相关性研究

目的:探讨原发性高血压患者血管紧张素Ⅱ(AngⅡ)与左心室肥厚(LVH)的相关性。方法:对2009年4月至2010年12月,高血压科住院行超声心动图(UCG)检查及其他临床资料完整的581例患者,进行回顾性分析;并通过二维引导的M-模式进行测量记录左心室结构,左心室质量指数(LV-MI),将高血压患者分为高血压伴LVH组(LVH组,n=100)和高血压不伴LVH组(NLVH组,n=481),分析AngⅡ与LVH间的相关性。结果:LVH组体质量指数、收缩压、脉压、肌酐(Scr)、肾素及AngⅡ均高于NLVH组(P<0.001)。以LVH为因变量,以收缩压、脉压、Scr及AngⅡ为自变量进行logistic回归分析,显示收缩压、脉压、Scr及AngⅡ与LVH相关,差异有统计学意义(P<0.05)。结论:收缩压、脉压、Scr及AngⅡ在原发性高血压患者左心室肥厚的发生发展过程中起重要作用。     

Impact of blood pressure control on prevalence of left ventricular hypertrophy in treated hypertensive patients

AIM: The aim of the present study was to evaluate (1) the prevalence and patterns of left ventricular hypertrophy (LVH) and (2) the impact of blood pressure (BP) control, assessed by clinical and 24-hour ambulatory BP monitoring (ABPM) criteria on the persistence of LVH in a representative sample of treated patients attending our Hypertension Clinic. METHODS: One hundred consecutive essential hypertensives (61 m/39 f, age 56+/- 9 years) regularly followed up by the same medical team (average period 52 months, 12-156 months) were included in the study and underwent 24-hour ABPM and complete echocardiographic examination. RESULTS: Twenty-eight of the 100 patients were found to have LVH [left ventricular mass index (LVMI) >125 g/m(2) in men and >110 g/m(2) in women]; LVH was eccentric in 20 patients and concentric in the remaining 8. LVMI did not correlate with clinical BP values but only with ABPM values (mean 24 h systolic r = 0.34, p <0.01; diastolic r = 0.37, p <0.01). The prevalence of LVH in patients controlled according to clinical BP criteria (n = 43, BP <140/90 mm Hg) was 19%, in patients controlled according to ABPM criteria (n = 30, BP during daytime <132/85 mm Hg) 17%, and in those controlled with both criteria (n = 16) 6% (p <0. 01). CONCLUSIONS: The results of this study suggest that the eccentric type of LVH is the prevalent pattern in chronically treated patients. The persistence of LVH is significantly dependent on BP levels achieved during treatment; indeed the prevalence of LVH is very low in patients with an optimal BP control, whereas it is elevated (37%) in uncontrolled patients.     

Assessment of self-monitoring of blood pressure in the diagnosis of isolated clinic hypertension

BACKGROUND: There are no studies assessing cardiovascular morbidity, morality in patients with isolated clinical hypertension (ICH) with self-blood pressure monitoring (SBPM). OBJECTIVES: To determine the value of SBPM in the diagnosis of ICH. METHODS: Cohort study. New hypertensive and normotensive patients 15-75 years, without cardiovascular events history. VARIABLES: Oriented anamnesis hypertension; blood pressure measurements (BP): clinical BP, SBPM and ambulatory BP monitoring (ABPM); evaluation of target organ damage (TOD); electrocardiogram; retinography and microalbuminuria (MA). RESULTS: One hundred and thirty-five patients, 95 hypertensive (62.1% males; mean age 59.08+/-16.8 years), 40 normotensive (37.5% males; mean are 56.32+/-10.22 years). BP measurements (mmHG) in normotensives vs hypertensives: clinical BP, 125.36/76.74 vs 149.81/87.86 mmHg (p<0.0001) and SPPM, 114.90/69.96 vs 142.06/86.31 (p<0.0001). Twenty-four-hour ABPM: 135.41/81/81.74. Prevalence of TOD in hypertensive: 23.10% left ventricular hypertrophy (LVH), sustained hypertension (SH): clinic BP, 149.88/86.34 vs 152.51/89.55 (p>0.10); SBPM: 147.895/88.95 vs 128.17/79 (p<0.0001) and ABPM, 141.72/88.22 vs 131.66/80 (p=0.053 for systolic). TOD in SH vs ICH: LVH, 24.6% vs 19.2% (p=0.814); exudates or haemorrhages, 7.7% vs 9.8% (p=0.580). The risk of an occurrence of any TOD in ICH patients is lower for 125/80 (OR=2.5). CONCLUSIONS: VAMPAHICA will provide information about value SBPM in the diagnosis of ICH. Advanced retinopathy is relative frequent in ICH patients. If TOD is accepted as a surrogate endpoint, the diagnostic values of ICH will be probably decreased.     

Efficacy of indapamide 1.5 mg, sustained release, in the lowering of systolic blood pressure

The relationship between the increase in blood pressure and the incidence of cardiovascular disease is well recognized today. Studies have shown that more attention should be paid to systolic blood pressure (SBP) in relation to cardiovascular risk and that therapeutic interventions should preferably focus on reducing SBP. The antihypertensive efficacy of indapamide 1.5 mg sustained release (indapamide SR), a low-dose thiazide-type diuretic, was assessed on SBP. Three randomized, double-blind, controlled studies were conducted with indapamide SR, over a period of 3 to 12 months. Elderly patients or patients with target-organ damage, hypertension and left ventricular hypertrophy (LVH) (LIVE study) or with type II diabetes with microalbuminuria (NESTOR study) showed a decrease in SBP varying from 22.7 to 31.8 mmHg. The treatment with indapamide SR resulted in a better or equivalent control of SBP than treatment with a standard dose of a true thiazide diuretic (hydrochlorothiazide), a calcium channel blocker (amlodipine), and an angiotensin-converting enzyme inhibitor (enalapril). No therapeutic escape was observed. All treatments showed good acceptability with no unexpected adverse event. In conclusion, indapamide SR is very effective in lowering SBP-a major independent cardiovascular risk factor-notably in hypertensive high-risk patients with LVH, the elderly and diabetics, when compared to major antihypertensive treatments. This SBP-lowering effect is maintained over the long term.     

Effect of twelve-month combined therapy with perindopril and indapamide on the level of blood pressure and left ventricular hypertrophy in patients with hypertensive disease

Left ventricular hypertrophy (LVH) in patients with hypertensive disease is associated with unfavorable prognosis. Long term and effective antihypertensive therapy is capable to cause reverse development of LVH. We included in this study 72 patients (27 men, 45 women, age from 34 to 72 years) with untreated 1st and 2nd degree arterial hypertension (systolic blood pressure 140-179 mm Hg and/or diastolic blood pressure 99-109 mm Hg) and echocardiographical signs of LVH (left ventricular myocardial mass index >120 g/m2 in men and >100 g/m2 in women). After that the patients were randomized into 2 groups: the study group (39 patients, mean age 53.0+/-11.6 years) received combination of perindopril and indapamide in initial dose of 2 mg/0.625 mg, and comparison group (33 patients, mean age 54.4+/-8.2 years) received monotherapy with enalapril (10 mg). Once daily dosing of the preparation provided high level of compliance of patients with treatment. During 12-month therapy with combination of perindopril and indapamide target blood pressure (<140/90) was achieved in 74.4% of patients, during monotherapy with enalapril--in 27.3% of patients. Significant decrease of left ventricular myocardial mass index (LVMMI) with combination therapy was observed by 6th month of treatment (from 260 to 234 g), with monotherapy within same period of time--from 267 to 260 g. As a result of 12 months therapy of patients with I-II degree of hypertension with perindopril and indapamide LVMMI decreased by 17.5% while monotherapy with enalapril was associated with 5.6% decrease of LVMMI. Lowering of LVMMI occurred mainly at the account of decrease of left ventricular wall thickness.     

Further evidence for low-dose combinations in patients with left ventricular hypertrophy

Left ventricular hypertrophy (LVH) is a powerful independent risk predictor for cardiovascular disease and reversal of LVH has become a primary goal of antihypertensive management. Recent evidence has confirmed that most hypertensive patients will benefit from a low-dose combination strategy to manage their hypertension, and two trials have recently examined the effect of this strategy on left ventricular mass. The REASON study (pREterax in regression of Arterial Stiffness in a contrOlled double-bliNd study) compared the low-dose combination of an angiotensin-converting enzyme (ACE) inhibitor and a diuretic with beta-blocker monotherapy in hypertensive patients with LVH, and the PICXEL study (Preterax In a double-blind Controlled study versus Enalapril in LVH) compared the same low-dose combination with ACE inhibitor monotherapy in hypertensive patients with echocardiographic LVH. The REASON study demonstrated that the low-dose combination produced a significantly greater change in left ventricular mass after 1 year than the beta-blocker, despite inducing a similar change in mean blood pressure. Additionally, perindopril/indapamide reduced central (carotid) and peripheral (brachial) systolic blood pressure (SBP) and pulse pressure (PP) to a significantly greater extent than beta-blocker, and these benefits were more pronounced for the central values; LVH is affected more by central rather than peripheral haemodynamic changes. Results of the analysis of the PICXEL study showed a significantly greater decrease in LVH parameters and blood pressure over 1 year in favour of the low-dose combination. This reduction cannot be entirely explained by the better efficacy of the low-dose combination on blood pressure reduction.