Gerdts E, Svarstad E, Aanderud S, Myking O L, Lund-Johansen P, Omvik P
Department of Heart Disease, Haukeland Hospital, Bergen, Norway.
Am J Hypertens. 1998 Oct;11(10):1178-87. doi: 10.1016/s0895-7061(98)00194-0.
The effect of doxazosin versus captopril on blood pressure, albuminuria, and left ventricular mass was studied in 33 hypertensive type-1 diabetic patients randomized to 6 months treatment with captopril (17 patients, mean daily dose 100 mg) or doxazosin (16 patients, mean daily dose 9 mg). Casual and 24-h ambulatory blood pressure (24hBP) were reduced from 163/95 to 144/83 mm Hg and 152/86 to 145/81 mm Hg, respectively, in the captopril group, and from 160/93 to 145/86 mm Hg and 156/86 to 147/79 mm Hg in the doxazosin group (all P < .05). The achieved 24hBP on treatment was positively associated with pretreatment levels of glycosylated hemoglobin (HbA1c) and plasma atrial natriuretic peptide (r = 0.53 and 0.59, respectively, both P < .01). Albuminuria did not change significantly in either group. Left ventricular hypertrophy was present in 13 patients (7 in the captopril and 6 in the doxazosin group). Left ventricular mass was reduced by an average of 27% and 23%, respectively, in these patients (both P < .01), but did not change significantly in patients without left ventricular hypertrophy. The reduction in left ventricular mass was positively associated with the presence of baseline left ventricular hypertrophy and inversely with dietary sodium intake and achieved casual blood pressure on treatment (R2 = 0.59, P < .001). We conclude that doxazosin and captopril used for 6 months are equally effective in reducing blood pressure and left ventricular hypertrophy in hypertensive type-1 diabetic patients; the antihypertensive effect is closely related to glycemic control; and dietary sodium intake and achieved casual blood pressure after treatment are independent determinants of the reduction in left ventricular mass seen in these patients.
在33例1型糖尿病高血压患者中，研究了多沙唑嗪与卡托普利对血压、蛋白尿和左心室质量的影响。这些患者被随机分为两组，分别接受6个月的卡托普利治疗（17例，平均每日剂量100 mg）或多沙唑嗪治疗（16例，平均每日剂量9 mg）。卡托普利组的偶测血压和24小时动态血压（24hBP）分别从163/95 mmHg降至144/83 mmHg和从152/86 mmHg降至145/81 mmHg，多沙唑嗪组分别从160/93 mmHg降至145/86 mmHg和从156/86 mmHg降至147/79 mmHg（所有P <.05）。治疗后达到的24hBP与治疗前糖化血红蛋白（HbA1c）和血浆心钠素水平呈正相关（r分别为0.53和0.59，均P <.01）。两组蛋白尿均无明显变化。13例患者存在左心室肥厚（卡托普利组7例，多沙唑嗪组6例）。这些患者的左心室质量分别平均降低了27%和23%（均P <.01），但无左心室肥厚的患者左心室质量无明显变化。左心室质量的降低与基线左心室肥厚的存在呈正相关，与饮食钠摄入量和治疗后达到的偶测血压呈负相关（R2 = 0.59，P <.001）。我们得出结论，多沙唑嗪和卡托普利治疗6个月在降低1型糖尿病高血压患者血压和左心室肥厚方面同样有效；降压效果与血糖控制密切相关；饮食钠摄入量和治疗后达到的偶测血压是这些患者左心室质量降低的独立决定因素。
