氯沙坦治疗对血压达标及左心室舒张功能影响的研究

目的探讨血管紧张素Ⅱ1型受体拮抗剂氯沙坦治疗对血压达标及左心室舒张功能的影响。方法多中心、开放、自身前后对照试验设计,给予患者52周抗高血压治疗,其中初治的高血压患者给予氯沙坦为主的联合降压方案;而经治的高血压患者血压仍未达标者加用氯沙坦等联合降压。将70例患者分为两组,<65岁组(40例)目标血压<140/90mmHg(1mmHg=0.133kPa),≥65岁组(30例)血压达标为<150/90mmHg。试验最终有55.71%的患者为单药氯沙坦治疗,25.71%及18.58%的患者分别为2种和3种以上药联合治疗。达标率<65岁组为87.50%,≥65岁组为83.33%。结果经氯沙坦治疗52周后患者左心室的室间隔和左心室后壁厚度均有明显的改善。在<65岁组二尖瓣舒张早期血流峰速(E)/舒张晚期血流峰速(A)比值(E/A)增加,而在≥65岁组左心室射血分数有所增加,其增加量与舒张压降低幅度呈负相关。结论以氯沙坦为基础的联合降压方案在抗高血压治疗达标的同时,能够改善左心室的舒张功能。但随年龄的增长,药物对其病程的干预及逆转作用并不完全一致。

Effect of losartan treatment on alleviating hypertension to the goal and left ventricular diastolic dysfunction

Objective To investigate the effect of losartan,a selective angiotensin II type-1 receptor blocker,on left ventricular diastolic dysfunction while lowering the blood pressure to the goal.Methods In a multi-centre open study,patients were randomized to 52-week treatment with losartan or losartan plus other antihypertensive drugs,and the comparison was made before and after treatment.The goal for the blood pressure was <140/90 mm Hg for patients <65 years and <150/90 mm Hg for patients ≥65 years.Results At the end of the study,55.71% of the patients were treated with losartan only,25.71% with two drugs and 18.58% with three drugs.Of the patients aged <65 years,87.50% reached the goal,and the patients aged ≥65 years,83.33% reached the goal.After administration of losartan for 52 weeks,the thickness of interventricular septum and left ventricular posterior wall was improved obviously,the E/A ratio increased in patients <65 years and the LVEF increased in the patients ≥65 years.A negative correlation was observed between the increase in E/A and the decrease in systolic blood pressure in the patients <65 years;another negative correlation was found between increase in LVEF and decrease in diastolic blood pressure in the patients ≥65 years.Conclusion The results suggest that losartan and losartan-based combined antihypertensive treatment can improve the left ventricular diastolic function while lowering the blood pressure to the target.For the different ages,the pharmacological effects on the course of disease and left ventricular function are not the same.