缬沙坦治疗高血压病并逆转左心室肥厚改善心功能的临床研究

目的评估缬沙坦治疗高血压病的降压效果、安全性与逆转高血压心肌肥厚和改善心功能的疗效。方法以氨氯地平为对照药物，在老年性轻、中度高血压患者中进行随机、平行对照的临床研究。结果缬沙坦组患者治疗4周总有效率为60．8％（45／74），降压幅度15．6／10．9mmHg；治疗24周后总有效率为78．4％（54／74）．降压幅度21．1／17．9mmHg。缬沙坦组治疗24周后在逆转高血压心肌肥厚中取得满意的疗效，能显著逆转左室肥厚（LVH），左室后壁厚度（PWT），室间隔厚度（IVST），降低左室重量指数（LVMI），且缬沙坦组能有效地改善心功能．经治疗后患者的心脏每分输出量（CO）、左室射血分数（LVEF）、舒张早期与舒张晚期峰值流速的比值（E／A）、E峰减速度（Ede）均不同程度得到改善；缬沙坦组患者血尿酸、C-反应蛋白较治疗前明显下降，不良反应率为8．1％．主要是面红、头昏及心悸。心率、血生化、肝肾功能无明显变化。结论缬沙坦降压疗效好，且能逆转左心室肥厚，改善心功能，不良反应少，可作为治疗老年性轻、中度高血压伴左心室肥厚的一线药物。

Clinical Evaluation of Valsartan in Treating Hypertension and Reversing Left Ventricular Hypertrophy and Improving Cardiac Function

Objective To evaluate the efficacy and safety of valsartan in lowering hypertension, reversing left cardiac hypertrophy and improving cardiac function. Methods Randomized controlled clinical study was carried out in elderly patients with mild to moderate hypertension. The efficacy of valsartan was compared with amlodipine. Results In the valsartan treatment group, the efficacy rate was 60.8% （45/74）. The amplitude of reduction of blood pressure was 18.6/15.1 mmHg after 4 weeks of treatment. After 24 weeks of treatment, the efficacy rate was 78.4% （54/74） and the level of reduction was 21.1/17.9 mmHg. Left ventricular hypertrophy （LVH）, left ventricular posterior wall thickness （PWT）, ventricular septal thickness （IVST） were reversed and the left ventricular mass index （LVMI） was reduced after treatment with valsartan. Valsartan also effectively improved cardiac function, cardiac output （CO）, left ventricular ejection fraction （LVEF）, early diastolic peak flow velocity in the late diastolic ratio （E/A） and E peak decrease velocity（Edc）. The levels of uric acid and C-reactive protein were decreased after treatment with valsartan. Side effects, such as flushing, dizziness and cardiopalmus, were observed in 8.1% of patients in the Valsartan treatment group. Heart rate, blood biochemistry, liver and renal function were not significantly changed. Conclusion Valsartan can effectively reduce blood pressure, reverse left ventricular hypertrophy and improve cardiac function. Valsartan can be used as a first-line drug on treating mild to moderate hypertension with left ventricular hypertrophy in elderly patients.