雷米普利对血压得到控制且左心室射血分数正常的心血管疾病患者左心室质量及功能的影响：心脏转归预防评估（HOPE）试验的一项子研究

Effects of ramipril on left ventricular mass and function in cardiovascular patients with controlled blood pressure and with preserved left ventricular ejection fraction: a substudy of the Heart Outcomes Prevention Evaluation (HOPE) Trial.

作者信息

Lonn Eva, Shaikholeslami Roya, Yi Qilong, Bosch Jackie, Sullivan Brian, Tanser Paul, Magi Alison, Yusuf Salim

机构信息

Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

出版信息

J Am Coll Cardiol. 2004 Jun 16;43(12):2200-6. doi: 10.1016/j.jacc.2003.10.073.

DOI:10.1016/j.jacc.2003.10.073

PMID:15193680

Abstract

OBJECTIVES

The purpose of this study was to assess the effects of ramipril on left ventricular mass (LVM) and function in vascular disease patients with controlled blood pressure (BP) and with preserved left ventricular ejection fraction (LVEF).

BACKGROUND

Increased LVM and left ventricular (LV) volume and decreased LVEF predict clinical events. Angiotensin-converting enzyme inhibitors reduce LVM and LV volume and preserve LVEF in patients with hypertension and/or LV dysfunction, but have not been studied in patients with controlled BP and preserved LVEF.

METHODS

We compared the effects of two doses of ramipril (10 mg/day and 2.5 mg/day) versus placebo in 506 patients with vascular disease on echocardiographic measures of LVM and LV function.

RESULTS

Baseline BP and LVEF were similar, 131/76 mm Hg and 58%, in all treatment groups. After four years, LVM index increased by 3.98 +/- 2.08 g/m2 in the placebo and by 4.16 +/- 1.86 g/m2 in the ramipril 2.5 mg/day groups and decreased by 2.02 +/- 2.25 g/m2 in the ramipril 10 mg/day group (p = 0.02). The changes in LV end-diastolic and end-systolic volumes were 4.16 +/- 2.55 ml and 5.31 +/- 1.67 ml in the placebo, -0.43 +/- 2.75 ml and 2.90 +/- 1.45 ml in the ramipril 2.5 mg/day, and -5.90 +/- 2.93 ml and -1.90 +/- 1.55 ml in the ramipril 10 mg/day groups (p = 0.02 and p = 0.001). The changes in LVEF were -2.02 +/- 0.72%, -1.54 +/- 0.74%, and -0.17 +/- 0.72%, respectively (p = 0.01).

CONCLUSIONS

Ramipril has beneficial effects on LV structure and function in vascular patients with controlled BP and with preserved LVEF.

摘要

目的

本研究旨在评估雷米普利对血压得到控制且左心室射血分数（LVEF）保留的血管疾病患者左心室质量（LVM）及功能的影响。

背景

LVM增加、左心室（LV）容积增加以及LVEF降低可预测临床事件。血管紧张素转换酶抑制剂可降低高血压和/或LV功能障碍患者的LVM和LV容积，并保留LVEF，但尚未在血压得到控制且LVEF保留的患者中进行研究。

方法

我们比较了两种剂量的雷米普利（10毫克/天和2.5毫克/天）与安慰剂对506例血管疾病患者LVM和LV功能的超声心动图测量结果的影响。

结果

所有治疗组的基线血压和LVEF相似，分别为131/76毫米汞柱和58%。四年后，安慰剂组的LVM指数增加了3.98±2.08克/平方米，雷米普利2.5毫克/天组增加了4.16±1.86克/平方米，雷米普利10毫克/天组降低了2.02±2.25克/平方米（p = 0.02）。LV舒张末期和收缩末期容积的变化在安慰剂组分别为4.16±2.55毫升和5.31±1.67毫升，雷米普利2.5毫克/天组为-0.43±2.75毫升和2.90±1.45毫升，雷米普利10毫克/天组为-5.90±2.93毫升和-1.90±1.55毫升（p = 0.02和p = 0.001）。LVEF的变化分别为-2.02±0.72%、-1.54±0.74%和-0.17±0.72%（p = 0.01）。