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目的探讨不同联合降压治疗对原发性高血压左心室肥厚(LVH)患者校正的Q-T离散度(QTcd)的影响。方法入选原发性高血压患者111例,包括单纯高血压患者60例(男34例,女26例),年龄(60.7±5.6)岁,及原发性高血压LVH患者51例(男28例,女23例),年龄(61.8±7.0)岁。原发性高血压LVH患者随机分为低剂量氨氯地平(2.5mg/d)加替米沙坦(40mg/d)组(n=26)和氨氯地平(2.5mg/d)加复方阿米洛利(半片/d)组(n=25),治疗1年。于治疗前后分别行心动超声检查,检测左心室质量指数(LVMI)等指标、测量QT间期(QT)、校正的QT间期(QTc)及QTcd等,并进行比较分析。血压正常者56名(男31名,女25名)作为对照组,年龄(59.3±6.7)岁。结果高血压LVH组、单纯高血压组及对照组一般临床特征相似。高血压LVH患者QTcd[(34±10)ms]较对照组和单纯高血压患者明显延长(均P<0.05)。氨氯地平加替米沙坦组和氨氯地平加复方阿米洛利组患者基线血压、QT、QTc、QTcd、LVMI、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室舒张末期内径(LVIDd)等临床指标差异无统计学意义(均P>0.05)。与治疗前比较发现,降压治疗1年后氨氯地平加替米沙坦和氨氯地平加复方阿米洛利联合治疗均能有效控制血压(均P<0.05),降低LVMI、IVST和LVPWT(均P<0.05),同时QTc、QTcd亦缩短(均P<0.05)。氨氯地平加替米沙坦组在降压及降低LVMI、IVST等方面优于氨氯地平加复方阿米洛利组(均P<0.05),且QTcd较氨氯地平加复方阿米洛利组明显缩短(P<0.01)。结论氨氯地平联合替米沙坦在有效控制血压,逆转LVH,改善心室厚度均匀性的同时,可明显改善心室肌复极同步性,其效果优于氨氯地平联合阿米洛利治疗。
Objective To investigate the effect of different combined antihypertensive treatment on the corrected Q-T dispersion (QTcd) in patients with essential hypertension with left ventricular hypertrophy (LVH). Methods A total of 111 patients with essential hypertension were enrolled in this study. They included 60 patients (34 males and 26 females) with age (60.7 ± 5.6) years and 51 hypertensive patients with LVH (28 males , 23 females), age (61.8 ± 7.0) years old. Patients with essential hypertension were randomly divided into low-dose amlodipine (2.5mg / d) plus telmisartan (40mg / d) group (n = 26) and amlodipine (2.5mg / d) Milill (half / d) group (n = 25) for 1 year. Before and after treatment, echocardiography, left ventricular mass index (LVMI) and other parameters were measured. QT, QTc and QTcd were measured and compared. Fifty-six (31 males and 25 females) with normal blood pressure were included as control group, with a mean age of (59.3 ± 6.7) years. Results The general clinical features of hypertensive LVH group, simple hypertensive group and control group were similar. QTcd [(34 ± 10) ms] in hypertensive patients with LVH was significantly longer than that in control subjects and patients with hypertension alone (all P <0.05). Baseline blood pressure, QT, QTc, QTcd, LVMI, IVST, LVPWT, left ventricle (LVPWT), amlodipine plus amiloride group There were no significant differences in clinical indexes such as end-diastolic diameter (LVIDd) (all P> 0.05). Compared with pre-treatment, the combination therapy of amlodipine and amlodipine plus amiloride could effectively control blood pressure (all P <0.05) and reduce LVMI, IVST and LVPWT after 1 year of antihypertensive treatment (All P <0.05), meanwhile QTc and QTcd also shortened (both P <0.05). Amlodipine plus telmisartan group is superior to amlodipine and amiloride in reducing blood pressure and lowering LVMI and IVST (all P <0.05), and QTcd is better than amlodipine plus amiloride Group was significantly shorter (P <0.01). Conclusion Amlodipine combined with telmisartan can effectively improve the ventricular repolarization synchronism while effectively controlling blood pressure, reversing LVH and improving the uniformity of ventricular thickness. The effect of amlodipine combined with telmisartan is better than that of amlodipine and amiloride.