科素亚对原发性高血压降压及对左室肥厚、左室功能改善的临床研究
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摘要
目的：观察Losartan(商品名科素亚)对原发性高血压(EH)患者血压(BP)及左室肥厚(LVH)、左室功能的影响。方法：轻、中度EH 34例，口服科素亚50mg／日，疗程4周。治疗前后测诊室坐位收缩压／舒张压(SiSBP／SiDBP)及心率(HR)；用超声心动图(UCG)测定心脏结构、左室功能、左室重量(LVM)、左室重量指数(LVMI)的变化；用动态血压监测(ABPM)观察血压、血压负荷(BPL)及血压变异(BPV)、谷／峰比率(T／P)。治疗前后测定血脂、空腹血糖、血尿酸、肾功能等。结果：治疗4周末，SiSBP／SiDBP显著下降(21.25±10.48)／(15.44±9.76)mmHg(1mmHg=0.1333kpa)，P＜0.001，降压总有效率96.87％；24小时及日间、夜间平均收缩压(SBP)、舒张压(DBP)、平均压(MAP)均降低，P＜0.001；血压负荷(BPL)明显减小，P＜0.001；血压变异(BPV)减小，P＜0.05；心输出量及心率无改变而左房(LA)、左室舒张末径(LVIDd)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、LVM、LVMI均下降，P＜0.001～0.01：射血分数增加(P＜0.05)及舒张早期充盈血量增加(P＜0.001～0.05)，等容舒张时间缩短(P＜0.001)。治疗后血尿酸
减少(尸<0.001)而不影响空腹血糖、血脂、肌醉、尿素氮等。结论:
科素亚治疗轻、中度EH，能在24小时内有效地、平稳地降低血压，
并能改善LVH、改善左室舒张功能、降低血尿酸，耐受性好，基本
无副作用。
Objects: To investigate the antihypertensive efficacy and the effects on left ventricular hypertrophy (LVH), and left ventricular function in patients with essential hypertension (EH). Methods: Thirty-four patients with mild to moderate EH were given Cozaar 50mg once daily for four weeks. Before and after the treatment, sitting systolic blood pressure (BP) and diastolic BP (SiSBP/SiDBP) heart rate (HR) were measured, Echocardiography was conducted to determine cardiac structure and function, left ventricular mass (LVM), LVM index (LVMI) and identical volume relax time (IVRT). Meanwhile, ambulatory blood pressure monitoring (ABPM) was applied to determine 24-hour, daytime and nighttime systolic BP (SBP), diastolic BP (DBP), mean arterial BP (MAP) , BP load (BPL), BP variability (BPV) , trough-to-peak ratio. Metabolic parameters such as blood lipid and fasting blood glucose, serum uric acid and renal function were measured before and after the treatment. Results: Four weeks treatment with Cozaar significantly decreased SiSBP/SiDBP, decreasing range of BP were (21.25
±10.48)7 (15.44±9.67)mmHg, (1mmHg=0.1333Kpa), P<0.001, total effective rate was 96.87%. SBP, DBP and MAP during 24-hour, daytime and nighttime were reduced significantly, P<0.001, BPL(P<0.001), BPV( P<0.001) were reduced, T/P>50%. There was no significantly difference about HR and cardiac output, but left atrium diameter (LA), left ventricular diastolic diameter (LVIDd), interventricular septal thickness (IVST), left ventricular posterior wall thickness(LVPWT), LVM, LVMI were all reduced (P<0.001-0.01), ejection fraction (EF) was increased (P<0.05), diastolic prime blood filling was improved (P<0.001-0.05), IVRT was shortened from baseline (P<0.001). Blood uric acid was reduced after the treatment, but it had no effect on fasting blood glucose, blood lipid, serum creatinine, urea nitrogen before and after the treatment. Conclusion: In patients with mild to moderate essential hypertension, Cozaar can effectively and steadily reduce blood pressure during 24-hour, reverse LVH, improve left ventricular diastolic function, lower serum uric acid and be generally well tolerated and less adverse effects.
减少(尸<0.001)而不影响空腹血糖、血脂、肌醉、尿素氮等。结论:
科素亚治疗轻、中度EH，能在24小时内有效地、平稳地降低血压，
并能改善LVH、改善左室舒张功能、降低血尿酸，耐受性好，基本
无副作用。
Objects: To investigate the antihypertensive efficacy and the effects on left ventricular hypertrophy (LVH), and left ventricular function in patients with essential hypertension (EH). Methods: Thirty-four patients with mild to moderate EH were given Cozaar 50mg once daily for four weeks. Before and after the treatment, sitting systolic blood pressure (BP) and diastolic BP (SiSBP/SiDBP) heart rate (HR) were measured, Echocardiography was conducted to determine cardiac structure and function, left ventricular mass (LVM), LVM index (LVMI) and identical volume relax time (IVRT). Meanwhile, ambulatory blood pressure monitoring (ABPM) was applied to determine 24-hour, daytime and nighttime systolic BP (SBP), diastolic BP (DBP), mean arterial BP (MAP) , BP load (BPL), BP variability (BPV) , trough-to-peak ratio. Metabolic parameters such as blood lipid and fasting blood glucose, serum uric acid and renal function were measured before and after the treatment. Results: Four weeks treatment with Cozaar significantly decreased SiSBP/SiDBP, decreasing range of BP were (21.25
±10.48)7 (15.44±9.67)mmHg, (1mmHg=0.1333Kpa), P<0.001, total effective rate was 96.87%. SBP, DBP and MAP during 24-hour, daytime and nighttime were reduced significantly, P<0.001, BPL(P<0.001), BPV( P<0.001) were reduced, T/P>50%. There was no significantly difference about HR and cardiac output, but left atrium diameter (LA), left ventricular diastolic diameter (LVIDd), interventricular septal thickness (IVST), left ventricular posterior wall thickness(LVPWT), LVM, LVMI were all reduced (P<0.001-0.01), ejection fraction (EF) was increased (P<0.05), diastolic prime blood filling was improved (P<0.001-0.05), IVRT was shortened from baseline (P<0.001). Blood uric acid was reduced after the treatment, but it had no effect on fasting blood glucose, blood lipid, serum creatinine, urea nitrogen before and after the treatment. Conclusion: In patients with mild to moderate essential hypertension, Cozaar can effectively and steadily reduce blood pressure during 24-hour, reverse LVH, improve left ventricular diastolic function, lower serum uric acid and be generally well tolerated and less adverse effects.
引文
1．刘治全．高血压的靶器官损害与动脉硬化危险因素的临床评估．见：刘治全，牟建军主编《高血压病诊断治疗学》．第一版．北京．北京医科大学、中国协和医科大学联合出版社，1998．41-53
2．刘治全．血压测量及高血压的分类和分期．见：刘治全，牟建军主编《高血压病诊断治疗学》．第一版．北京．北京医科大学、中国协和医科大学联合出版社，1998；29-40
3．刘国仗．高血压降压谷／峰比值的方法学及应用．见：中国高血压联盟、中华医学会继续教育部编：99中国高血压世纪行专题报告文集．北京．1999．48-49
4．中华心血管病杂志编委会心血管药物对策组．心血管药物临床试验评价方法的建议．中华心血管病杂志，1998；26(1)：5-11
5. Lo M W, Goldberg M R, McCrea J B, et al. Pharmacokinetics of losartan , an angiotensin Ⅱ receptor antagonist, and its active metabolite EXP3174 in humans. Clin Pharmacol Ther, 1995; 58(6): 641-649
6. John H, Bauer M D, Garry P, et al. The angiotensin Ⅱ typeⅠ receptor antagonists. Drug Therapy, 1995; 155:1361-1368
7. Franz H, Messerli M D, Michael A, et al. Angiotensin Ⅱ receptor inhibition, Arch Intern Med, 1996; 156:1957-1965
8. Tedesco -M A, Ratti-G, Aquino-D, et al. The effectiveness and tolerability of Iosartan and effect on left ventricular mass in patients with essential hypertension. Cardiologia. 1998; 43(1): 53-59
9. Cottone S, Vadala A, Vella M C, et al. Changes of plasma
endothelin and growth factor levels, and of left ventricular mass, after chronic AT1-receptor blockade in human hypertension. Am J Hypertens. 1998; 11(5): 548-553
10．莫俊歧．高血压病左室舒张功能减低的研究现状．中国心血管杂志，1998；3(3)：220-222
11. Franz H, Messerli MD, Michael A, et al. Angiotensin Ⅱ receptor inhibition. Arch Intern Med. 1996; 156:1957-1965
12. Theodore L, Goodfriend MD, Mary E, et al. Angiotensin receptors and their antagoists. Drug Therapy. 1996 ; 334(25):1649-1654
2．刘治全．血压测量及高血压的分类和分期．见：刘治全，牟建军主编《高血压病诊断治疗学》．第一版．北京．北京医科大学、中国协和医科大学联合出版社，1998；29-40
3．刘国仗．高血压降压谷／峰比值的方法学及应用．见：中国高血压联盟、中华医学会继续教育部编：99中国高血压世纪行专题报告文集．北京．1999．48-49
4．中华心血管病杂志编委会心血管药物对策组．心血管药物临床试验评价方法的建议．中华心血管病杂志，1998；26(1)：5-11
5. Lo M W, Goldberg M R, McCrea J B, et al. Pharmacokinetics of losartan , an angiotensin Ⅱ receptor antagonist, and its active metabolite EXP3174 in humans. Clin Pharmacol Ther, 1995; 58(6): 641-649
6. John H, Bauer M D, Garry P, et al. The angiotensin Ⅱ typeⅠ receptor antagonists. Drug Therapy, 1995; 155:1361-1368
7. Franz H, Messerli M D, Michael A, et al. Angiotensin Ⅱ receptor inhibition, Arch Intern Med, 1996; 156:1957-1965
8. Tedesco -M A, Ratti-G, Aquino-D, et al. The effectiveness and tolerability of Iosartan and effect on left ventricular mass in patients with essential hypertension. Cardiologia. 1998; 43(1): 53-59
9. Cottone S, Vadala A, Vella M C, et al. Changes of plasma
endothelin and growth factor levels, and of left ventricular mass, after chronic AT1-receptor blockade in human hypertension. Am J Hypertens. 1998; 11(5): 548-553
10．莫俊歧．高血压病左室舒张功能减低的研究现状．中国心血管杂志，1998；3(3)：220-222
11. Franz H, Messerli MD, Michael A, et al. Angiotensin Ⅱ receptor inhibition. Arch Intern Med. 1996; 156:1957-1965
12. Theodore L, Goodfriend MD, Mary E, et al. Angiotensin receptors and their antagoists. Drug Therapy. 1996 ; 334(25):1649-1654