坎地沙坦与氨氯地平对高血压左室肥厚患者心功能和尿微量白蛋白的疗效观察

目的探讨坎地沙坦和氨氯地平对高血压患者左室肥厚和尿微量白蛋白的疗效。方法对83例门诊原发性高血压(1级、2级)并左室肥厚患者随机分为坎地沙坦组(42例)和氨氯地平组(41例),分别予以坎地沙坦和氨氯地平治疗。于受试前、后分别测定血压及二维彩色B超,检测室间隔(IVS)、左室后壁厚度(LVPW)、左室舒张末内径(LVDd)、E/A、左室射血分数(EF)和左室重量指数(LVMI),同时测定尿微量白蛋白、血清尿素氮和肌酐。结果两组在受试2周后与治疗前相比,血压均开始明显下降(P<0.01),两组降压疗效相比差异无统计学意义。两组24周测IVS、LVPW、LVDd和LVMI,较治疗前明显降低(P<0.01),EF和E/A升高(P<0.01),24周后坎地沙坦组优于氨氯地平组(P<0.05)。两组治疗4周后尿微量白蛋白都有明显下降(P<0.01)。坎地沙坦组随用药时间的延长,尿微量白蛋白不断降低,24周后明显优于氨氯地平组(P<0.01)。两组治疗前后血清尿素氮和肌酐无明显变化(P>0.05)。结论坎地沙坦和氨氯地平都有良好的降压作用,并且能逆转左室肥厚、降低尿微量白蛋白,但坎地沙坦的保护作用优于氨氯地平。

The effect of candesartan vs amlodipine on left ventricular hypertrophy and microalbuminuria in patents with essential hypertension

Objective To explore the effect of candesartan vs amlodipine on left ventricular hypertrophy and microalbuminuria in patients with essential hypertension. Methods 83 patients with mild to moderate essential hypertension and left ventricular hypertrophy were randomly divided into candesartan group(n=42) and amlodipine group(n=41). Blood pressure monitoring, left ventricular diastolic diameter(LVDd), interventricular septal thick(IVS), left ventricular posterior wall(LVPW), left ventricular masss index(LVMI) were measured by echocardiography before and after 24 weeks' treatment in two groups. Microalbuminuria, serum nitrogen and creatinine were examined at the same time. Results Both SBP and DBP were significantly decreased in two groups after the treatment(P<0.01), there is no difference between the two groups after 24 weeks' treatment. The value of LVDd,IVS, LVPWT,LVMI and microalbuminuria in the two groups were significantly decreased compared with those before treatment respectively, and E/A ratio and EF were increased at the same time(P<0.01). After treatment, these change were more significant in candesartan group than that in amlodipine group(P<0.01). Serum nitrogen and creatinine were not changed in two groups after treatment(P>0.05). Conclusion Both Candesartan and Amlodipine can significantly lower blood pressure, left ventricular hypertrophy and decrease microalbuminuria, but candesartan is more effective than amlodipine.