Almazov V A, Shlyakhto E V, Konrady A O, Macsimova T A, Zaharov D V, Rudomanov O G
Faculty Therapy Dept., St. Petersburg Pavlov State Medical University, 6/8 Lev Tołstoy str., St. Petersburg 197089, Russia.
Med Sci Monit. 2000 Mar-Apr;6(2):309-13.
The aim of the study was to compare the effects of long-term treatment with different types of antihypertensive drugs on left ventricular hypertrophy (LVH) and diastolic function in patients with essential hypertension. We examined 60 patients with mild to moderate hypertension from 35 to 55 years old (middle age 44.3 +/- 2.3 yrs) having no concomitant diseases. Patients were treated for six months with different types of antihypertensive drugs: 21 patient received nifedipine-retard 40 mg/day, 20--atenolol 100 mg/day, 10--losartan potassium 100 mg/day, 9--perindopril 4 mg/day. Cardiac structure and function was studied by echocardiography. For the left ventricle (LV) the diastolic mass normalised for body surface area (LVMI), the ratio of the early and atrial mitral inflow velocities (E/A), isovolumetric relaxation time (IVRT), relative wall thickness (RWT) were measured. After six months of treatment LVMI decreased by 9% in nifedipine group (P < 0.01), by 10.5% in atenolol group (P < 0.01), by 12% in losartan group (P < 0.01) and by 8.2% in perindopril group (NS). RWT decreased in all groups, while diastolic dimension index remained unchanged. The reversal of LVH was not related to blood pressure reduction. It was more significant in patients with initially higher values of LVMI. Antihypertensive effects of the drugs were comparable. Long-term treatment with all types of selected drugs improves cardiac structure and function independently of their antihypertensive action. Our data suggest that on the basis of the influence on cardiac remodelling no preference for any studied drug can be discerned. The work had the following source of support: the atenolol (Falitonsin) and nifedipine-retard (Corinfar-retard) were provided by the AWD Company (Germany), losartan potassium has been provided by Merck Sharp & Dohme Company and perindopril (Prestarium) by the Servier Group.
本研究旨在比较不同类型的抗高血压药物长期治疗对原发性高血压患者左心室肥厚（LVH）和舒张功能的影响。我们检查了60例年龄在35至55岁（平均年龄44.3±2.3岁）的轻至中度高血压患者，他们无合并症。患者接受不同类型的抗高血压药物治疗六个月：21例患者接受硝苯地平缓释片40毫克/天，20例接受阿替洛尔100毫克/天，10例接受氯沙坦钾100毫克/天，9例接受培哚普利4毫克/天。通过超声心动图研究心脏结构和功能。对于左心室（LV），测量了经体表面积标准化的舒张期质量（LVMI）、二尖瓣流入早期和心房速度之比（E/A）、等容舒张时间（IVRT）、相对壁厚度（RWT）。治疗六个月后，硝苯地平组LVMI下降9%（P<0.01），阿替洛尔组下降10.5%（P<0.01），氯沙坦组下降12%（P<0.01），培哚普利组下降8.2%（无统计学意义）。所有组的RWT均下降，而舒张期内径指数保持不变。LVH的逆转与血压降低无关。在初始LVMI值较高的患者中更为显著。这些药物的降压效果相当。所有选定药物的长期治疗均可独立于其降压作用改善心脏结构和功能。我们的数据表明，基于对心脏重塑的影响，无法区分对任何所研究药物的偏好。本研究得到以下支持：阿替洛尔（Falitonsin）和硝苯地平缓释片（Corinfar-retard）由德国AWD公司提供，氯沙坦钾由默克夏普&多姆公司提供，培哚普利（Prestarium）由施维雅集团提供。
