硝苯地平和比索洛尔治疗原发性高血压前后左室舒张功能的探讨

对原发性高血压患 肖苯地平和比索洛尔，与正常血压组进行比较，高血压组比正常血压组舒张早期时间ⅡＡ－ＤⅡＡ－ＭＶＤ间期延长，左室充盈波Ａ增高，Ａ／Ｒ比增加。硝苯地平使高血压组舒张功能改善缩短。比索洛尔使高血压组ＭＶＯ－Ｄ间期延长，Ａ波振幅降低，改善左舒张功能。     

比索洛尔对老年高血压患者舒张功能的影响

高血压是心脑血管疾病的独立危险因素,其中左心室肥厚是高血压的心脏特征性病变之一[1].本文旨在探讨比索洛尔对高血压患者左室舒张功能的影响.     

小剂量比索洛尔、氯沙坦治疗对左室舒张功能的影响

目的观察小剂量比索洛尔合并氯沙坦治疗6个月前后病人左室舒张功能的影响.方法 36例高血压患者(Ⅰ级20例,Ⅱ级16例)使用5 mg比索洛尔和氯沙坦50 mg,连服6个月,不改变用药量,并于治疗前后用M超和二维超声测定左室舒张功能.结果治疗6个月后血压值由168±6/99±8 mmHg降到112±7/73±9 mmHg.治疗后左室舒张功能的左室舒张早期流速峰值(PE)和舒张早期流速积分(SE)明显增高,舒张晚期流速峰值(PA)明显降低,虽舒张晚期流速积分(SA)有降低,但无显著性差别.PA/PE由0.81±0.12降至0.56±0.25(P<0.01).结论小剂量比索洛尔、氯沙坦治疗对左室舒张功能有明显改善.     

比索洛尔治疗原发性高血压180例报告

目的：观察比索洛尔对轻中度高血压的降压疗效及其安全性。方法：采用自身对照开放试验方法。180例原发性高血压（EH）病人，服安慰剂1周后，口服比索洛尔5～20mg（80％病人服5～10mg）共6周，不服其它降血压药。结果：服药6周后血压为18．6±1．77／11．3±1．05kPa，收缩压下降4.0kPa，舒张压下降2．4kPa，有效31．1％，显效67．2％，总有效率98．3％；36例冠心病人中19例心绞痛及心肌缺血好转改善率为52．7％。出现不良反应20例（11．1％），但症状轻，不需停药。治疗前后血生化及肝肾功能无改变。结论：比索洛尔对轻中度EH病人具有降压作用，对合并冠心病者兼有抗缺血效应，不良反应少，耐受性好。     

比索洛尔对原发性高血压患者左室肥厚逆转效应

目的: 探讨比索洛尔对原发性高血压病左室肥厚的逆转作用。方法: 选择40例轻中度高血压病伴左室肥厚患者，口服比索洛尔24周，测量服药前后血压变化；通过超声心动图测量患者服药前后舒张末期室间隔厚度（LVST），舒张末期左室后壁厚度（LVPWT），左室舒张末内径（LVEDD），左心室质量指数（LVMI）。检测服药前后血清中Ⅲ型前胶原（PCⅢ），胰岛素样生长因子（IGF-I），肿瘤坏死因子-α（TNF-α）的变化。结果: 治疗后上述指标较治疗前明显减低，差异有显著性（P<0.01）。结论: 比索洛尔能有效降低血压并逆转左室肥厚，其机制可能与抑制IGF-I、TNF-α的生成有关。     

比索洛尔加小剂量氢氯噻嗪治疗原发性高血压

目的 观察比索洛尔加小剂量氢氯噻嗪治疗原发性高血压的疗效和安全性.方法 原发性高血压86例,随机分为对照组和观察组各43例,对照组单用比索洛尔2.5mg,晨服,每日1次;观察组在对照组治疗基础上再加用氢氯噻嗪12.5mg,晨服,每日1次.两组疗程均为1个月,测量治疗前、后的血压、心率、血脂、血糖、肝功能、肾功能、血电解质.结果 经治1个月后观察血压下降,对照组总有效率72%,观察组总有效率93%,差异有统计学意义(P＜0.05),两组均无不良事件发生.结论 治疗高血压,比索洛尔加小剂量氢氯噻嗪比单用比索洛尔疗效更好.     

不同剂量比索洛尔对老年高血压病并发舒张性心力衰竭左室舒张功能的影响

目的: 观察不同剂量的比索洛尔对舒张性心力衰竭患者左室舒张功能的影响。方法: 92例高血压病并发左室舒张功能不全但左室射血分数（LVEF）>50%的患者,在氨氯地平控制血压达标（<140/90 mmHg）的基础上,按照加用比索洛尔的剂量随机分为3组:对照组（不用比索洛尔组,n=31）,低剂量组（加用比索洛尔1.25 mg,1次/d,n=30）,高剂量组（加用比索洛尔5 mg,1次/d,n=31）,平均随访观察30周。采用超声多普勒心动图评估治疗前后左室结构和功能参数的变化。结果: 3组治疗后LVEF和收缩压无明显改变,舒张压和心率在低剂量组和高剂量组下降明显（P<0.05）。加用比索洛尔治疗后,患者E峰、A峰、E/A、E峰流速积分（VTIE）、A峰流速积分（VTIA）、流速时间积分比率(E-VTI/A-VTI）有不同程度改善,高剂量组较低剂量组改善更加显著（P<0.05）。左室舒张末内径（LVEDD）、室间隔厚度（IVSD）、左室后壁厚度（PWT）、左室质量指数（LVMI)在高剂量组变化显著(P<0.05),对照组无显著改善。结论: 在氨氯地平降压达标基础上,比索洛尔能够进一步改善高血压病患者左室舒张功能,较大剂量作用更加显著。     

国产比索洛尔治疗原发性高血压71例临床观察

应用国产比索洛尔对７１例原发性高血压病人进行１个月的疗效观察，发现绝大多病人口服比索洛尔５ｍｇ／ｄ，可使其收缩压及舒张压显著下降，且心率的下降程度与血压的下降程度相符。该药在降压治疗中对血脂代谢有轻度影响，可使血清甘油三酯有上升趋势，而对其它肝肾功能及血糖、电解质无影响。     

比索洛尔对原发性高血压患者临床疗效及糖脂代谢的影响

目的评价比索洛尔对于原发性高血压患者降压效果及糖脂代谢的影响。方法 60例我院门诊及住院的原发性高血压患者,实验开始前曾服用过左旋氨氯地平2.5mg/d。治疗前其坐位血压稳定并且满足收缩压≥160mmHg和(或)舒张压≥95mm-Hg的要求。每日口服2.5mg～10mg比索洛尔片剂,均为一次给药,同时建议所有患者降低食盐摄入量至5g/d～7g/d。所有患者均根据心率、血压情况先给予比索洛尔片剂初始剂量2.5mg,每两周剂量增加2.5mg,直至10mg/d。观察患者治疗前及治疗后24周的坐位血压、空腹血糖水平和血红蛋白(HbA1c)水平,75g葡萄糖负荷前及负荷后30min、60min、120min血糖和血浆胰岛素水平,血胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平。结果比索洛尔联合用药前后血压有明显下降,用药后患者血脂、血糖、胰岛素敏感性等指标与用药前相比,差异无统计学意义。结论在治疗原发性高血压方面,比索洛尔联合用药降压具有较好的有效性和安全性。     

高血压右室与左室舒张功能的关系

对64例Ⅰ、Ⅱ期临床无心功能不全表现的高血压患者，32例年龄与性别相匹配的健康者，应用多普勒超声心动图技术，对其右室舒张功能进行测定，同时测定其左室收缩及舒张功能并作比较，高血压组按超声心动图标准分为左室肥厚组（LVH）34例，无左室肥厚组（NLVH）30例。测定结果表明,NLVH组与正常组比较，前者通过三尖瓣的E峰较低（P＜0.05），A峰较高（P＜0.05），E／A比值较小（P＜O.01)，快速充盈分数(PFF），l／3充盈数(1／3EF）和校正的充盈率峰值（PFR）也降低（P＜0.05），下降时间（DT）延长（P＜0.01）。LVH组中上述各参数与正常组比较也均有降低，与NLVH组比较A峰、E／A比值和PFR有进一步损害。相关分析发现，右室充盈参数与左室充盈参数密切相关（r从0.45到0.80）。     

高血压病左室舒张功能异常超声心动图各项指标相关性分析

应用脉冲多普勒超声法测定39例较中度高血压病（EH）患者和正常人左室舒张功能各项参数，进行相关性分析，结果显示：EH组PVE变小，PVA增大，PVE／PVA比值缩小，IRT延长，LVmass和LVmI增加，LAD增大，均与对照组相差显著（P＜0．05～0001）。PVE／PVA，IRT和LVmass均与MAP呈相关性（r＝－0.37，0．37，0．41）；LVmass与PVE／PVA，IRT，LAD和LVmI相关性好（r＝－0．41，0．38，0．53，0．96）；且IRT与PVE／PVA呈负相关（r＝－0．43）。研究表明，EH患者早期常出现左室舒张功能异常，测量PVE／PVA及IRT便捷、直观。左室舒张功能受累还常伴有左房内径扩大和LVmI增加。     

Two‐Dimensional Ultrasound Speckle Tracking Imaging in Evaluation of Early Changes in Left Ventricular Diastolic Function in Patients with Essential Hypertension

Objective: To investigate two‐dimensional ultrasound speckle tracking imaging (STI) in evaluating values of early changes in left ventricular diastolic function in patients with essential hypertension (EH). Methods: Seventy‐five EH patients with left ventricular normal geometry (LVN), including 38 cases with nonleft atrial enlargement (NLAE) and 37 cases with left atrial enlargement (LAE), and 50 healthy persons were enrolled as study participants. Two‐dimensional images of LV apical four‐chamber view, two chamber view, and LV long‐axis view and short‐axis view of mitral annular, papillary muscle, and apical levels were obtained to measure early diastolic E′ peak value, late diastolic A′ peak value, and E′/A′ ratio at LV apical longitudinal strain rate (SrL) and short‐axis radial strain rate (SrR), circumferential strain rate (SrC), and rotation rate (RotR) in all cardiac segments. Average values of E′, A′, and E′/A′ at SrL in three segments on long‐axis and SrR, SrC, and RotR on three short‐axis levels were calculated. Untwisting rate (Untw R) and untwisting half‐time (UHT) were also calculated. Results: (1) Data on 110 of 125 patients were usable for STI analysis. (2) There were no intersegment significant differences between A′ at SrL in three segments or interlevel significant differences between A′ at SrR in three levels in the NLAE group and the LAE group. (3) Compared with the normal group, E′ at SrL and E′/A′ at SrL, SrR and SrC, and Untw R reduced in the NLAE group and the LAE group, while A′ at SrL, SrR, and SrC and E′ at RotR increased and UHT extended. Conclusion: STI may be helpful for the detection of early changes in left ventricular diastolic function in patients with EH. (ECHOCARDIOGRAPHY 2010;27:146‐154)     

Quality of Life Comparison Between Bisoprolol and Nifedipine Retard in Hypertension

Quality of life with the selective beta1-blocker bisoprolol and the calcium channel blocker nifedipine as a retard formulation was compared in patients with essential hypertension. A multicenter randomized, double-blind, two-way, crossover study design was used. After a placebo run-in period (4–6 weeks), during which all antihypertensive therapy was withdrawn, 82 patients were randomized. During the active treatment periods (8 weeks each), patients received either bisoprolol once daily or nifedipine retard twice daily, using the double-dummy technique. A washout period (4–6 weeks) separated the treatment periods. Data at baseline (at randomization) and at the end of each treatment period were compared. Seventy-five patients completed the study. Blood pressure (168 ± 2/103 ± 1 mmHg) decreased (p > 0.001) similarly with bisoprolol (153 ± 2/90 ± 1 mmHg) and nifedipine (154 ± 2/90 ± 1 mmHg). Compared with baseline values, none of the quality of life variables investigated changed during bisoprolol or nifedipine retard use. Neither in the intention-to-treat nor the efficacy analysis were differences between bisoprolol and nifedipine found in quality of life variables, such as the Health Status Index, somatic symptoms, anxiety, depression, total psychiatric morbidity, cognitive symptoms, and hostility score. Only in the efficacy analysis did Health Status Index tend to be better (p = 0.055) during nifedipine intake when compared with bisoprolol. This trend was not present in the intention-to-treat analysis. The number of dropouts during bisoprolol (n = 2) and nifedipine (n = 3) treatment, and the number of patients reporting side effects (21% and 16%, respectively) did not differ (p = 0.64) between both treatments. It can be concluded that at equipotent antihypertensive dosages, an 8-week treatment period with the selective beta1-blocker bisoprolol or the calcium antagonist nifedipine as a retard formulation does not result in any difference in quality of life variables. It is not clear whether the trend of Health Status Index to become better during nifedipine intake, which was only found in the efficacy analysis and not in the intention-to-treat analysis, is of clinical relevance.     

高血压患者左室构型改变与左心舒张功能

目的探讨高血压患者不同左室构型改变与左心舒张功能的关系。方法应用超声心动图和定量组织速度成像技术检测109例原发性高血压患者和26例对照组左心结构及舒张功能各项指标。按照Ganau分类法将高血压患者左室构型分为正常左室构型(A)、向心性重构(B)、向心性肥厚(C)、离心性肥大(D)4种构型,并与对照组(N)比较,对各项指标进行单因素方差分析。结果高血压B、C、D组等容舒张时间(IVRT)延长,后间隔基底段(PS Bas)[N:(84.8±23.4),B:(118.9±34.6),C:(133.1±34.6),D:(161.9±62.5)ms,P<0.05];等容舒张期峰值速度(VIR)B、C组和A组的多数节段高于对照组;对照组16.3%节段出现等容舒张期正向波,83.7%为负向波,高血压组64%节段出现等容舒张期正向波,36%为负向波;快速充盈期心肌沿长轴的峰值速度(Ve)高血压组均低于对照组;B、C两组Ve/Va减低。高血压组左房径均大于对照组,B、C、D组逐渐增大。二尖瓣口血流频谱B、C两组VE/VA<1,而在D组VE/VA>1。结论不同左心室构型高血压患者的左心舒张功能均有减低。应用QTVI能够检出二尖瓣血流频谱VE/VA正常的舒张功能异常,并能检测出等容舒张期局部心肌的异常活动,较频谱多普勒更加敏感。     

DTI技术评价卡维地洛对高血压左室舒张功能的影响

目的 评价卡维地洛对高血压左室舒张功能（LVDF）的影响。方法 采用多普勒组织成像（DTI）技术分析正常人和轻中度高血压左室肥厚组（LVH组）和非左室肥厚组（非LVH组）患者的二尖瓣环的舒张早期，晚期运动速率（Ea,Aa)，并与血流多普勒法检测的二尖瓣口舒张早期，晚期最大速度（E，A）比较，对E／A和Ea/As均＜1者给予卡维地洛（10－20mg／日）治疗12周，观察降压疗效及LVDF的变化。结果 1．高血压组Ea,Ea/As,E,E/A较正常组明显降低，A值明显升高（P＜0．01），而Aa值二组间无差异。EA,Ea/As在LVH组比非LVH组进一步降低（P＜0．05），而E，E／A二组间无差异（P＞0．05）。2 卡维地洛作用 用药12周后，SBP，DBP明显降低（P＜0．01），心率无明显变化。Ea,Ea/As及E，E／A升高，非LVH组A值降低（P＜0．05），LVH组A值无明显变化。结论 DTI技术可较血流多普勒法更敏感准确地反映严重LVDF受损患者的左室舒张功能。卡维地洛对轻中工高血压病具有良好降压作用并能改善左室舒张功能。     

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.     

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.     

硝苯地平控释片治疗高血压临床观察

目的研究硝苯地平控释片疗效。方法３３例高血压患者接受硝苯地平控释片治疗４周。结果总有效率为７５．８％，以Ⅰ期高血压疗效显著（８８．９％），Ⅱ期７８．９％，Ⅲ期６０．０％。结论硝苯地平控释片副作用轻，能维持２４ｈ药效，服用方便     

氨氯地平与硝苯地平治疗高血压的临床研究

比较在轻度至中度高血压中用氨氯地平及硝苯地平治疗4周的疗效与安全性，结果显示氨氯地平降压作用缓慢而持久，早期血管性不良反应较少。无停药后高血压性反跳效应，不影响神经内分泌系统。