缬沙坦氨氯地平片对高血压患者左室舒张功能和动脉顺应性影响的超声学评价

目的应用超声技术评价缬沙坦氨氯地平片（商品名：倍博特）对高血压左心室（LV）舒张功能及动脉顺应性的影响。方法选择90例原发性高血压患者分为LV构型异常组（42例）和LV构型正常组（48例），均予缬沙坦氨氯地平片1片（含缬沙坦80mg，氨氯地平5mg），po，qd。分别于给药前、给药3和6个月测量血压、脉压和体质量指数，应用超声心动图测定各受试者左房内径（LAD）、左室内径（LVDd及LVDs）、室壁厚度和相对室壁厚度（RWT）、左室质量指数（LVMI）、左室射血分数（LVEF）；运用多普勒超声和组织多普勒（TDI）分别记录二尖瓣口的血流频谱（E、A、E／A）和二尖瓣环的运动速度频谱（e’、a’），计算E／e’、e’／a’；运用颈总动脉超声检查测左侧颈总动脉内中膜厚度（IMT）、最大径（Dmax）、最小径（Dmin），计算颈动脉动脉顺应性（AC）、血管僵硬参数（β）和压力应变弹性系数（Ep）。结果原发性高血压LV构型异常组的e’／a’低于LV构型正常组（P〈0．05），而E／e’β、Ep高于LV构型正常组（P〈0．05）。给予缬沙坦氨氯地平片治疗3和6个月，与用药前基线值相比，IMT以Ep、E／e’降低（P〈0．05），AC、e’／a’增高（P〈0．05），LV构型正常组干预6个月时恢复至正常值范围。LV构型异常组在干预3个月时左室舒张末期容积、每搏输出量恢复至正常值范围，6个月时LAD、RWT、LVMI恢复至正常值范围，但E／e’、e’／a’、β、Ep与LV构型异常组仍有差别（P〈0．05）。结论原发性高血压患者LV舒张功能、动脉弹性的减低，早于动脉结构及心脏构型的改变。缬沙坦氨氯地平片口服3和6个月，对LV构型正常的高血压患者可以改善心脏舒张功能和动脉弹性，对LV构型异常的高血压患者，逆转心脏的重构，形态结构恢复正常，但心脏舒张功能和动脉硬化的参数未完全正常。

Echocardiographic assessment of effects of amlodipine/valsartan combination on left ventricular diastolic function and arterial compliance in patients with hypertension

AIM To evaluate the impact of amlodipine/valsartan combination on left ventricular （LV） diastolic function and arterial compliance in patients with hypertension by ultrasound imaging. METHODS A total of 90 patients with essential hypertension were divided into abnormal LV geometry group（ n = 42） and normal LV geometry group（ n = 48） .All patients were treated with amlodipine/valsartan combination（valsartan 80 rng / amlodipine 5 mg ）one tablet, po, qd. The blood pressure（BP）, pulse pressure（PP） and body mass index（BMI）were recorded; the left atrium diameter （LAD）, LV diameter （ LVDd, LVDs）, wall thickness and relative wall thickness （RWT）, left ventricular mass index （LV-MI） and left ventricular ejection fraction （LVEF） were measured by echocardiography before and after 3,6 month-therapy respectively. The mitral valve flow pattern（MVFP）（ E, A） and mitral annulus velocity （e＇, a＇） were recorded using Doppler echocardiography and tissue Doppler imaging（TDI）respectively, and the E/e＇ and e＇/a＇were counted. The left common carotid artery （CCA） intima-media thickness （IMT） and carotid diameter （Dmax, and Omin） were measured through carotid echocardiography; the carotid arterial compliance （AC）, vascular stiffness parameters （β）, pressure- strain elasticity modulus （Ep） were calculated. RESULTS Compared with normal LV geometry group, essential hyper- tention with abnormal LV geometry group had lower value of e＇/a＇ （ P 〈 0.05） and higher value of E/e＇, β, Ep （ P 〈 0.05） .After the treatment with amlodipine/valsartan combination for 3 months and 6 months, IMT,β, Ep, E/e＇ were decreased （P 〈 0.05）,while AC, e ＇/a＇ were increased （P 〈 0.05）, and these parameters were normal at 6 months drug therapy in normal LV geometry group（ P 〉 0.05）. LVEDV,SV were normal at 3 months, and LAD, RWT, LVMI were normal at 6 months in abnormal LV geometry group, and the value of E/e＇, e＇/a＇, β, Ep were significantly differ- ent between the abnormal LV geometry group and the control （ P 〈0. 05）. CONCLUSION Decrease in LV diastolic function and arterial compliance of essential hypertension is earlier than change of arterial structure and heart geometry in patients with primary hypertension. Three and 6 month amlodipine/valsartan combination therapy could improve their di- astolic function and arterial compliance in the normal LV geometry group. It could reverse heart remodeling, and normal- ize heart morphology in the abnormal LV geometry group, but it couldn＇t restore the abnormal parameters of diastolic function and arterial stiffness in these patients.