Chang Nen-Chung, Shih Chun-Ming, Bi Wei-Fung, Lai Zhi-Yang, Lin Mei-Shu, Wang Tze-Che
Division of Cardiology, Department of Medicine, Taipei Medical University and Hospital, Taipei, Taiwan.
Cardiovasc Drugs Ther. 2002 Mar;16(2):141-7. doi: 10.1023/a:1015757500567.
To clarify whether fosinopril monotherapy can improve left ventricular diastolic function (LVDF) in young mildly hypertensives without hypertrophy, we studied 66 patients (pts) with diastolic blood pressure 90-100 mmHg, aged <45 years, with normal 2-dimensional echocardiography (2-D echo), and impaired DF. Impaired DF was defined as a Doppler transmitral early (E) to atrial (A) filling velocity ratio (E/A ratio) <1. Thirty-eight pts were selected for fosinopril monotherapy. Mean age was 36 years. Duration of documented hypertension was 5.4 years. Mean daily dose of fosinopril was 20 mg. Twenty-eight controls were treated with hydrochlorothiazide and hydralazine combination. Sixty-six age- and sex-matched healthy subjects served to establish normal reference values of 2-D and Doppler echo measurements. All hypertensives were treated for 30 months and re-examined 4 weeks after cessation of treatment. The fosinopril-treated group showed improvements in transmitral E (52 +/- 8 cm/s, vs. 61 +/- 9 cm/s, p < 0.01), A (56 +/- 9 cm/s, vs. 47 +/- 6 cm/s, p < 0.05), and E/A ratio (0.93 +/- 0.16, vs. 1.29 +/- 0.18, p < 0.01). Moreover, the early to atrial velocity-time integral ratio (1.31 +/- 0.10, vs. 2.24 +/- 0.10, p < 0.001) improved. The pulmonary venous flow pattern normalized after fosinopril therapy. LV mass index, relative wall thickness, LV dimension, left atrial dimension, fractional shortening, heart rate, and body mass index did not change. The hydrochlorothiazide-hydralazine combination-treated group did not show an improved diastolic function. It is concluded that long-term fosinopril monotherapy leads to an improvement of impaired LVDF in young mildly hypertensives without hypertrophy.
为了明确福辛普利单药治疗能否改善无心肌肥厚的年轻轻度高血压患者的左心室舒张功能（LVDF），我们研究了66例舒张压为90 - 100 mmHg、年龄小于45岁、二维超声心动图（2 - D echo）正常但舒张功能受损的患者（pts）。舒张功能受损定义为二尖瓣血流舒张早期（E）与心房（A）充盈速度比值（E/A比值）小于1。38例患者被选入福辛普利单药治疗组。平均年龄为36岁。记录的高血压病程为5.4年。福辛普利的平均日剂量为20 mg。28例对照组患者接受氢氯噻嗪和肼屈嗪联合治疗。66例年龄和性别匹配的健康受试者用于建立二维和多普勒超声心动图测量的正常参考值。所有高血压患者接受治疗30个月，并在治疗停止后4周重新检查。福辛普利治疗组的二尖瓣E峰速度（52±8 cm/s，vs. 61±9 cm/s，p<0.01）、A峰速度（56±9 cm/s，vs. 47±6 cm/s，p<0.05）和E/A比值（0.93±0.16，vs. 1.29±0.18，p<0.01）均有所改善。此外，舒张早期与心房速度时间积分比值（1.31±0.10，vs. 2.24±0.10，p<0.001）也得到改善。福辛普利治疗后肺静脉血流模式恢复正常。左心室质量指数、相对室壁厚度、左心室尺寸、左心房尺寸、缩短分数、心率和体重指数均未改变。氢氯噻嗪 - 肼屈嗪联合治疗组的舒张功能未得到改善。结论是，长期福辛普利单药治疗可改善无心肌肥厚的年轻轻度高血压患者受损的左心室舒张功能。
