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目的:评价比索洛尔方案对伴左室肥厚的年轻高血压患者降压疗效影响,并观察其对左室肥厚的逆转作用。方法:单中心、随机、阳性药物对照、非劣效设计的开放研究。选取伴左室肥厚的年轻高血压患者64例,平均年龄(48.6±7.4)岁,随机分为比索洛尔治疗组(比索洛尔±氨氯地平)和氯沙坦对照组(氯沙坦±氨氯地平),每组32例,随访1年,测量服药前后血压、心率变化;超声心动图测量服药前后室间隔舒末厚度、左室后壁舒末厚度、E/A比值、左室射血分数(LVEF)变化,并比较两用药方案之间上述指标的差异。结果:比索洛尔组24 h平均收缩压由(138.6±12.5)降至(126.4±9.3)mm Hg,24 h平均舒张压由(89.9±10.2)降至(74.4±6.7)mm Hg,差异有统计学意义(P<0.05);氯沙坦组24 h平均收缩压由(136.9±9.6)降至(124.3±6.2)mm Hg,24 h平均舒张压由(86.5±7.6)降至(74.6±7.6)mm Hg,差异有统计学意义(P<0.05)。但两组间治疗前后血压差值均无统计学意义。比索洛尔组IVSTd由(12.84±1.33)降至(12.02±1.22)mm;左心室质量指数(LVMI)由(135±11.98)降至(110±10.53)g·m-2,差异有统计学意义(P<0.05)。氯沙坦组IVSTd由(12.76±1.16)降至(12.07±1.02)mm;LVMI由(134±12.84)降至(112±11.08)g·m-2,差异有统计学意义(P<0.01)。比索洛尔组E/A比值由(0.82±0.29)增至(1.07±0.26),差异有统计学意义(P<0.05)。氯沙坦组E/A比值由(0.79±0.33)增至(0.93±0.28),差异无统计学意义。结论:对于伴左室肥厚的年轻高血压患者,比索洛尔与氯沙坦方案治疗效果相当。比索洛尔为基础的治疗方案能有效降低年轻高血压患者的血压水平,显著逆转其左室肥厚;与氯沙坦组相比,可有效改善左心室舒张功能指标E/A值。
OBJECTIVE: To evaluate the antihypertensive effect of bisoprolol on hypertensive young patients with left ventricular hypertrophy and to observe its reversal effect on left ventricular hypertrophy. METHODS: Single center, randomized, positive drug control, open study of noninferiority design. A total of 64 young hypertensive patients with left ventricular hypertrophy were selected and their mean age was (48.6 ± 7.4) years and were randomly divided into bisoprolol treatment group (bisoprolol ± amlodipine) and losartan control group (losartan ± Amlodipine). Each group was followed up for one year. The changes of blood pressure and heart rate before and after taking the medicine were measured. Echocardiography was used to measure the thickness of the interventricular septum, the end-diastolic thickness of left ventricular wall, E / A ratio, Blood fraction (LVEF) changes, and compare the difference between the two indicators of the above programs. Results: The average systolic blood pressure decreased from (138.6 ± 12.5) to (126.4 ± 9.3) mm Hg in 24 hours in bisoprolol group and from (89.9 ± 10.2) to (74.4 ± 6.7) mm Hg in 24 hours (P <0.05). The average systolic blood pressure in losartan group decreased from (136.9 ± 9.6) to (124.3 ± 6.2) mm Hg in 24 h and decreased from (86.5 ± 7.6) to (74.6 ± 7.6) mm Hg, the difference was statistically significant (P <0.05). But before and after treatment, blood pressure difference between the two groups had no statistical significance. IVSTd decreased from (12.84 ± 1.33) to (12.02 ± 1.22) mm in bisoprolol group, and (135 ± 11.98) to (110 ± 10.53) g · m-2 in left ventricular mass index Significance (P <0.05). The IVSTd decreased from (12.76 ± 1.16) to (12.07 ± 1.02) mm in the losartan group and from (134 ± 12.84) to (112 ± 11.08) g · m-2 in the losartan group (P <0.01) . Bisoprolol group E / A ratio increased from (0.82 ± 0.29) to (1.07 ± 0.26), the difference was statistically significant (P <0.05). Losartan group E / A ratio (0.79 ± 0.33) increased to (0.93 ± 0.28), the difference was not statistically significant. CONCLUSIONS: Bisoprolol and losartan are equally effective in treating young hypertensive patients with left ventricular hypertrophy. Bisoprolol-based treatment regimen can effectively reduce the blood pressure of young hypertensive patients, significantly reverse the left ventricular hypertrophy; compared with losartan, can effectively improve the left ventricular diastolic function index E / A value.