以替米沙坦为基础降压治疗对原发性高血压患者心肌肥厚及左心室功能的影响  

Effects of Telmisartan-based Therapy on Left Ventricular Hypertrophy and Left Ventricular Function in Patients with Essential Hypertension

作　　者：潘秀娣[1] 曾昭华[1] 梁丽英[2] 温燕杭[3] 肖霭仪[4] 朱巧洪[1] 陆东风[1] 王玮[1] 何兆初[1] 易家骥[1] 区碧如[1] 何文凯[1] 

机构地区：[1]广州医学院第一附属医院心内科,广东广州510120 [2]广州医学院第一附属医院保健科,广东广州510120 [3]广州医学院第一附属医院超声科,广东广州510120 [4]广州医学院第一附属医院放射科,广东广州510120

出　　处：《今日药学》2009年第11期27-31,共5页Pharmacy Today

基　　金：广州市科技局基金资助项目(项目编号:2006C13G0021)

摘　　要：目的观察以替米沙坦为基础的降压治疗对原发性高血压患者的心肌肥厚及左心室功能的影响。方法选取未经治疗的单纯原发性高血压患者,予以口服替米沙坦80 mg/d,1次/d为基础的降压治疗。降压达标后超声心动图确诊合并心肌肥厚的患者共237例。因伴发其它疾病而排除195例(占82.28%),其中因冠心病排除136例,占排除病例的69.74%,余下41例为单纯高血压合并心肌肥厚患者(占17.30%),该41例是最终研究对象。治疗1年后,用超声心动图复查该41例患者左心室肥厚及左心室功能的变化情况。结果1.单纯高血压合并心肌肥厚患者的血压水平高,收缩压(189.21±19.91)mmHg,舒张压(101.40±16.92)mmHg;2.以替米沙坦为基础的降压治疗能有效降低血压,替米沙坦单药降压达标率17.07%;3.与治疗前相比,患者室间隔舒张末期厚度(IVS)、左心室后壁舒张末期厚度(LVPW)、左心室重量(LVM)、左心室重量指数(LVM I)均明显下降(P<0.01),射血分数(EF)提高(P<0.05),心肌肥厚和左心室收缩功能改善;4.而左房内径(LA)无显著变化;5.治疗前患者左心室舒张功能已下降(E/A比值0.97±0.38),1年后左心室舒张功能进一步下降(P<0.05),左心室舒张功能下降趋势不变。结论临床上高血压合并左心室肥厚患者多伴发其它疾病,以冠心病为多;原发性高血压致左心室肥厚是左心室后负荷增加引起;替米沙坦阻断AT1受体,有很好的降压作用,在降压同时逆转心肌肥大,改善左心室收缩功能,但不能逆转心肌纤维化和左心室舒张功能的下降。Objective To evaluate the effects of Telmisartan-based therapy on left ventricular hypertrophy and left ventricular function in patients with essential hypertension. Methods Untreated patients with simple essential hypertension were given Telmisartan-based （80 mg/d ） therapy. When the blood pressures stepped down to normal standard, 237 patients were diagnosed with left ventricular hypertrophy by echocardiography. Among them, 195 patients were ruled out because of other coexisted diseases, of which were excluded out of coronary heart disease, the ratio was 69.74% of all the excluded cases. The 41 left patients were simple essential hypertension with left ventricular hypertrophy （17. 30% ）, which were the final observed targets. The changes of left ventricular hypertrophy and left ventricular function were checked and recorded by echocardiography after 1 year. Results 1. The blood pressure extent of simple essential hypertension with left ventricular hypertrophy was quite high： the systolic pressure was （189.21 ± 19.91 ） mmHg, the diastolic pressure was （ 101.40 ± 16.92） mmHg; 2. Telmisartan-based therapy was effective for the treatment of essential hypertension, the efficient ratio of monotelmisartan was 17. 07%; 3. Afer 1-year-treatment, the interventricular septum （IVS）, diastolic left ventricular posterior wall thickness （LVPW）, left ventricular massiveness （LVM）, left ventricular massiveness index （LVMI） reduced sharply （P 〈 0.01 ）, the ejection fraction （EF） was elevated （ P 〈 0.05 ）, the left ventricular hypertrophy was reversed and the left ventricular systolic function was improved ; 4. the inside diameter of left atrium （LA） had no changes; 5. Pre-treatment, the ratio of E/A, indicating the left ventricular diastolic function, was declined （ the ratio of E/A was 0.97 ± 0.38 ）, the left ventricular diastolic function dropped down even more seriously （ P 〈 0.05 ） 1-year later, the declining trend of left ventricular diastolic function mai

关 键 词：高血压 心肌肥厚 心功能 心室重构 替米沙坦 

分 类 号：R972[医药卫生—药品]