培哚普利和坎地沙坦联合治疗原发性高血压左心室肥厚和颈动脉重塑疗效观察

目的探讨培哚普利和坎地沙坦联合治疗原发性高血压（EH）患者左心室肥厚（LVH）及颈动脉重塑的疗效。方法将142例伴LVH的EH患者随机分为培哚普利组（n=44）、坎地沙坦组（n=55）和联合治疗组（n=43）。设定目标血压值为收缩压（SBP）〈140mmHg和舒张压（DBP）〈90mmHg。3组患者分别口服起始剂量培哚普利4mg/d、坎地沙坦4mg/d和培哚普利4mg/d加坎地沙坦4mg/d。随访4周,若血压未能达标,则增加剂量,最大剂量为培哚普利8mg/d加坎地沙坦8mg/d。同时3组患者均口服氢氯噻嗪25mg/d,总疗程均为36周。检测治疗前后24h动态血压、心率（HR）、左室舒张末期内径（LVDd）、室间隔厚度（IVST）、左室舒张末期后壁厚度（LVPW）、左室质量指数（LVMI）和心胸比率（CTR）,检测颈动脉内膜-中膜厚度（IMT）、内径（ID）及IMT/ID。结果（1）3组治疗后24hSBP、24hDBP均分别较治疗前显著降低（P〈0.05）,而3组间比较差异无统计学意义（P〉0.05）;（2）3组治疗后LVDd、IVST、LVPW、LVMI、HR和CTR均分别较治疗前显著性降低（P〈0.05）,颈总动脉和颈内动脉IMT减小、ID增加、IMT/ID比值改善（P〈0.05或P〈0.01）,其中联合治疗组疗效最为显著（P〈0.05或P〈0.01）。结论培哚普利和坎地沙坦联合用药在逆转LVH、抑制心脏交感活性及改善颈动脉重塑方面较培哚普利或坎地沙坦单独用药具有更为显著的作用,且这些作用独立于降压疗效之外。

Effects of combined treatment with perindopril and candesartan on essential hypertension patients with left vertricular and carotid arterial remodeling

Objective To examine the effects of combined treatment with perindopril and candesartan on essential hypertension（EH） patients with left vcntricular hypertrophy （LVH） and carotid arterial remodeling. Methods A total of 142 EH patients with LVH were divided randomly into three groups：perindopril group received perindopril 4mg per day, candesartan group received candisartan 4mg per day, combined treatment group received perindopril 4mg and candisartan 4mg per da. All groups received dihydrochiorothiazide （DHCT） 25mg per day. If patients＇ SBP still ≥140mm Hg or DBP≥90mm Hg in the next four weeks, the dose of perindopril or candesartan would be increased to tiwce as belore until BP fell to the normal base level（ SBP 〈 140ram Hg and DBP 〈 90mm Hg）. The entire treatment would last for 36weeks. The 24-hour ambulatory blood pressure monitoring（ABPM）, heart rate （HR）, left ventricular end-diastolic dimension （LVDd）, left ventricular spetal （IVST）, left ventricular end-diastolic wall thickness （LVPWT）, left ventricular mass index （LVMI）, cardiothoracic ratio （CTR） ,intima-media thickness（IMT） and inner diameter（ID） of dommon carotid artery（CCA） ,internal carotid artery（ICA） were examined before and after treatment for confirmming the efficacy of medication. Results （ 1 ） The 24h SBP an d 24h DBP of patients in three groups decreased significantly after treatment （ all P 〈 0.05 ） , but there is not markedly difference in decreasing amplitude among the three groups （ all P 〉 0.05 ）. （ 2 ） LVDd, IVST, LVPWT, LVMI, HR, CTR, IMT, ID, IMT/ID of patients in three groups decreased or improved significantly after treatment（P 〈 0.05 or 0.01 ）. and the decreasing or improving amplitude of LVDd, LVMI, HR, CTR, IMT, IMT/ID of patients in combined treatment group were markedly higher than those of the other two groups （P 〈 0.05 or P 〈0. 01 ）. Conclusion Combined treatment with perindoril and candesartan has more intensive effect on