基于心超技术评价青年高血压并发左室肥厚疗效的药物流行病学研究
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摘要
目的:探讨高血压并发左室肥厚青年患者使用比索洛尔治疗方案的降压疗效,以心脏超声技术检查结果评价比索洛尔对左室肥厚的有效性。方法:采用分层整群抽样的方法抽取高血压并发左室肥厚患者的青年病例,根据降压药物使用情况分为暴露组(比索洛尔+氨氯地平)和对照组(氯沙坦+氨氯地平),暴露组患者数206例,对照组患者数231例,比较患者治疗前后的血压、左室射血分数(LVEF)、左室质量指数(LVMI)、舒张早期二尖瓣口峰值流速/舒张晚期二尖瓣口峰值流速(E/A)、舒张早期二尖瓣环运动速度/舒张晚期二尖瓣环运动速度(Em/Am)的变化,并比较两组的有效性。结果:暴露组降压有效率为86. 89%,对照组降压有效率为84. 85%,组间差异无统计学意义(P> 0. 05)。暴露组患者收缩压由(150. 71±18. 32) mm Hg降至(127. 95±11. 36) mm Hg,舒张压由(96. 53±7. 72) mm Hg降至(84. 61±5. 49) mm Hg,差异均有统计学意义(P <0. 01);对照组患者收缩压由(151. 23±17. 84) mm Hg降至(129. 67±13. 78) mm Hg,舒张压由(99. 25±7. 46) mm Hg降至(85. 77±4. 30) mm Hg,差异均有统计学意义(P <0. 01);但两组间的基线状态、治疗后收缩压、舒张压差异均无统计学意义(P> 0. 05)。暴露组患者E/A值由(0. 77±0. 14)升高至(0. 85±0. 12),Em/Am值由(0. 60±0. 13)升高至(0. 72±0. 11),对照组患者E/A值由(0. 78±0. 13)升高至(0. 86±0. 12),Em/Am值由(0. 65±0. 10)升高至(0. 77±0. 11),各组组内的差异均有统计学意义(P <0. 05),但两组间的基线状态、治疗后E/A、Em/Am的差异均无统计学意义(P> 0. 05)。两组患者LVEF均呈上升趋势、LVMI均呈下降趋势,但组内及组间的差异均无统计学意义(P> 0. 05)。结论:高血压并发左室肥厚青年患者使用比索洛尔治疗方案的有效性与氯沙坦差异没有统计学意义,可以推荐比索洛尔用于青年高血压并发左室肥厚患者的治疗。
Objective: To evaluate the anti-hypertensive effect and effect on left ventricular hypertrophy of bisoprolol-based therapy in young hypertension patients with left ventricular hypertrophy. Methods: By stratified cluster sampling,the patients with hypertension complicated with left ventricular hypertrophy were selected. The patients were divided into two groups according to the patients' medication: exposed group( bisoprolol + amlodipine,206 cases) and control group( losartan + amlodipine,231 cases). Changes of blood pressure,left ventricular mass index( LVMI),left ventricular ejection fraction( LVEF),early diastolic transmitral velocity/late diastolic transmitral velocity( E/A),early diastolic tissue velocity/late diastolic tissue velocity( Em/Am) were compared before and after treatment. Results: There was no significant difference in effectiveness between exposed group and control group( 86. 89% vs. 84. 85%)( P > 0. 05). The systolic blood pressure in the exposed group decreased from( 150. 71 ± 18. 32) mm Hg to( 127. 95 ± 11. 36) mm Hg,and the diastolic blood pressure decreased from( 96. 53 ± 7. 72) mm Hg to( 84. 61 ± 5. 49) mm Hg,which were significantly different from that before treatment( P < 0. 01). The systolic blood pressure in the control group decreased from( 151. 23 ± 17. 84)mm Hg to( 129. 67 ± 13. 78) mm Hg,and the diastolic blood pressure decreased from( 99. 25 ± 7. 46) mm Hg to( 85. 77 ±4. 30) mm Hg,which were significantly different from that before treatment( P < 0. 01). There were no significant difference in blood pressure between the two groups before and after treatment( P > 0. 05). The E/A value of exposed group increased from( 0. 77 ± 0. 14) to( 0. 85 ± 0. 12),which was significantly different from that before treatment( P < 0. 05).The E/A value of control group increased from( 0. 78 ± 0. 13) to( 0. 86 ± 0. 12),which was significantly different from that before treatment( P < 0. 05). The Em/Am value of exposed group increased from( 0. 60 ± 0. 13) to( 0. 72 ± 0. 11),which was significantly different from that before treatment( P < 0. 05). The Em/Am value of control group increased from( 0. 65 ± 0. 10) to( 0. 77 ± 0. 11),which was significantly different from that before treatment( P < 0. 05). There were no significant differences in E/A value and Em/Am value between the two groups before and after treatment( P > 0. 05).There were an upward trend in LVEF and a downward trend in LVMI in both groups,but the difference was not statistically significant( P > 0. 05). Conclusion: The difference between effect of bisoprolol and losartan on left ventricular hypertrophy in young hypertension patients is not statistically significant. The bisoprolol can be used as an alternative to the young hypertension patients with left ventricular hypertrophy.
Objective: To evaluate the anti-hypertensive effect and effect on left ventricular hypertrophy of bisoprolol-based therapy in young hypertension patients with left ventricular hypertrophy. Methods: By stratified cluster sampling,the patients with hypertension complicated with left ventricular hypertrophy were selected. The patients were divided into two groups according to the patients' medication: exposed group( bisoprolol + amlodipine,206 cases) and control group( losartan + amlodipine,231 cases). Changes of blood pressure,left ventricular mass index( LVMI),left ventricular ejection fraction( LVEF),early diastolic transmitral velocity/late diastolic transmitral velocity( E/A),early diastolic tissue velocity/late diastolic tissue velocity( Em/Am) were compared before and after treatment. Results: There was no significant difference in effectiveness between exposed group and control group( 86. 89% vs. 84. 85%)( P > 0. 05). The systolic blood pressure in the exposed group decreased from( 150. 71 ± 18. 32) mm Hg to( 127. 95 ± 11. 36) mm Hg,and the diastolic blood pressure decreased from( 96. 53 ± 7. 72) mm Hg to( 84. 61 ± 5. 49) mm Hg,which were significantly different from that before treatment( P < 0. 01). The systolic blood pressure in the control group decreased from( 151. 23 ± 17. 84)mm Hg to( 129. 67 ± 13. 78) mm Hg,and the diastolic blood pressure decreased from( 99. 25 ± 7. 46) mm Hg to( 85. 77 ±4. 30) mm Hg,which were significantly different from that before treatment( P < 0. 01). There were no significant difference in blood pressure between the two groups before and after treatment( P > 0. 05). The E/A value of exposed group increased from( 0. 77 ± 0. 14) to( 0. 85 ± 0. 12),which was significantly different from that before treatment( P < 0. 05).The E/A value of control group increased from( 0. 78 ± 0. 13) to( 0. 86 ± 0. 12),which was significantly different from that before treatment( P < 0. 05). The Em/Am value of exposed group increased from( 0. 60 ± 0. 13) to( 0. 72 ± 0. 11),which was significantly different from that before treatment( P < 0. 05). The Em/Am value of control group increased from( 0. 65 ± 0. 10) to( 0. 77 ± 0. 11),which was significantly different from that before treatment( P < 0. 05). There were no significant differences in E/A value and Em/Am value between the two groups before and after treatment( P > 0. 05).There were an upward trend in LVEF and a downward trend in LVMI in both groups,but the difference was not statistically significant( P > 0. 05). Conclusion: The difference between effect of bisoprolol and losartan on left ventricular hypertrophy in young hypertension patients is not statistically significant. The bisoprolol can be used as an alternative to the young hypertension patients with left ventricular hypertrophy.
引文
1李丹,张灵健,刘美,等.复方制剂缬沙坦——氨氯地平治疗原发性高血压meta分析[J].中国公共卫生,2018,34(2):305-309
2 杨事达,宫建,杨传家,等.老年女性高血压患者甲状腺激素水平的初步分析[J].慢性病学杂志,2014,15(3):201-202
3 宫建,杨传家,陈海平,等.老年高血压患者甲状腺激素水平的初步分析[J].河南医学研究,2014,23(12):19-20
4孙宁玲,Chen JW,王继光,等.亚洲高血压合并左心室肥厚诊治专家共识[J].中华高血压杂志,2016,24(7):619-627
5 Salvetti M,Paini A,Bertacchini F,et al. Changes in left ventricular geometry during antihypertensive treatment[J].Pharmacol Res,2018,134:193-199
6 宫建,郭凤,李翠英,等.预防医学理念在临床药学多维实践考核评价体系构建中的作用[J].中国公共卫生,2016,32(11):1602-1604
7 潘雯,宫建. 3D可视化、3D打印、虚拟现实、增强现实在医学中作用的研究进展[J].实用医学杂志,2017,33(17):2969-2971
8 李丹,宫建,孙晓辉,等.住院高血压患者的药物利用研究[J].中南药学2017,15(10):1470-1472
9 杨事达,宫建,杨朋,等.高血压老年男性患者甲状腺功能的临床分析[J].中国医学工程,2014,22(5):11-13
10 仉立辉,宫建,杨朋,等.老年女性2型糖尿病患者甲状腺结节超声特征的临床分析[J].中华妇幼临床医学杂志(电子版),2016,12(1):35-39
11 冯颖青.高血压合并左心室肥厚——what’s news?[J].中华高血压杂志,2017,25(7):616-619
12 匡泽民,王瑛,王佳洁,等.比索洛尔干预伴左室肥厚的年轻高血压患者效果研究[J].中国新药杂志,2017,26(16):1923-1929
13 Singh A,Mehta Y. Heart failure with preserved ejection fraction(HFp EF):Implications for the anesthesiologists[J]. J Anaesthesiol Clin Pharmacol,2018,34(2):161-165
2 杨事达,宫建,杨传家,等.老年女性高血压患者甲状腺激素水平的初步分析[J].慢性病学杂志,2014,15(3):201-202
3 宫建,杨传家,陈海平,等.老年高血压患者甲状腺激素水平的初步分析[J].河南医学研究,2014,23(12):19-20
4孙宁玲,Chen JW,王继光,等.亚洲高血压合并左心室肥厚诊治专家共识[J].中华高血压杂志,2016,24(7):619-627
5 Salvetti M,Paini A,Bertacchini F,et al. Changes in left ventricular geometry during antihypertensive treatment[J].Pharmacol Res,2018,134:193-199
6 宫建,郭凤,李翠英,等.预防医学理念在临床药学多维实践考核评价体系构建中的作用[J].中国公共卫生,2016,32(11):1602-1604
7 潘雯,宫建. 3D可视化、3D打印、虚拟现实、增强现实在医学中作用的研究进展[J].实用医学杂志,2017,33(17):2969-2971
8 李丹,宫建,孙晓辉,等.住院高血压患者的药物利用研究[J].中南药学2017,15(10):1470-1472
9 杨事达,宫建,杨朋,等.高血压老年男性患者甲状腺功能的临床分析[J].中国医学工程,2014,22(5):11-13
10 仉立辉,宫建,杨朋,等.老年女性2型糖尿病患者甲状腺结节超声特征的临床分析[J].中华妇幼临床医学杂志(电子版),2016,12(1):35-39
11 冯颖青.高血压合并左心室肥厚——what’s news?[J].中华高血压杂志,2017,25(7):616-619
12 匡泽民,王瑛,王佳洁,等.比索洛尔干预伴左室肥厚的年轻高血压患者效果研究[J].中国新药杂志,2017,26(16):1923-1929
13 Singh A,Mehta Y. Heart failure with preserved ejection fraction(HFp EF):Implications for the anesthesiologists[J]. J Anaesthesiol Clin Pharmacol,2018,34(2):161-165