Dahlöf B, Hansson L
University of Gothenburg, Ostra Hospital, Sweden.
J Hypertens. 1992 Dec;10(12):1513-24. doi: 10.1097/00004872-199210120-00012.
Primarily to investigate the long-term effects of antihypertensive therapy on left ventricular morphology in non-malignant essential hypertension and in particular to compare an angiotensin converting enzyme inhibitor and a diuretic in this respect.
Previously untreated males aged 20-65 years with diastolic blood pressure > or = 95 mmHg during a 4- to 6-week placebo period were randomly assigned to double-blind treatment with enalapril or hydrochlorothiazide.
Indirect and intra-arterial blood pressure, echocardiography, apex cardiography, carotid pulse tracing and phonocardiography.
Left ventricular mass (LVM) was significantly correlated with intra-arterial blood pressure at baseline. During long-term treatment (14-18 months) blood pressure decreased significantly in both treatment groups (indirectly and intra-arterially), at rest and during dynamic exercise. No significant differences in blood pressure response were seen between the two therapeutic alternatives. LVM decreased progressively and significantly on enalapril after 18 months of monotherapy and decreased non-significantly on hydrochlorothiazide after 14 months of monotherapy. The difference in effect between treatments was significant in a stepwise regression analysis taking change in blood pressure into account. The relationship between the reductions in LVM and blood pressure were significant for enalapril but not for hydrochlorothiazide. Neither therapy affected left ventricular diastolic or systolic diameters significantly, but enalapril reduced posterior wall thickness and interventricular septal thickness significantly, and improved left ventricular distensibility significantly. Neither therapy had any negative effects on systolic function, although hydrochlorothiazide decreased left ventricular ejection time index significantly.
Enalapril was significantly more effective than hydrochlorothiazide in reversing left ventricular hypertrophy without negatively affecting left ventricular function.
主要研究抗高血压治疗对非恶性原发性高血压患者左心室形态的长期影响，尤其是比较血管紧张素转换酶抑制剂和利尿剂在这方面的作用。
在4至6周的安慰剂期内，舒张压≥95 mmHg的20至65岁未经治疗的男性被随机分配接受依那普利或氢氯噻嗪的双盲治疗。
间接和动脉内血压测量、超声心动图、心尖心动图、颈动脉脉搏描记和心音图。
基线时左心室质量（LVM）与动脉内血压显著相关。在长期治疗（14至18个月）期间，两个治疗组的血压（间接和动脉内）在静息和动态运动时均显著下降。两种治疗方法在血压反应上无显著差异。单药治疗1个月后依那普利使LVM逐渐且显著降低，单药治疗14个月后氢氯噻嗪使LVM降低但不显著。在考虑血压变化的逐步回归分析中，治疗效果的差异显著。依那普利使LVM降低与血压降低之间的关系显著，而氢氯噻嗪则不然。两种治疗均未显著影响左心室舒张或收缩直径，但依那普利显著降低后壁厚度和室间隔厚度，并显著改善左心室扩张性。两种治疗对收缩功能均无负面影响，尽管氢氯噻嗪显著降低左心室射血时间指数。
依那普利在逆转左心室肥厚方面比氢氯噻嗪显著更有效，且对左心室功能无负面影响。
