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目的:探讨对血管紧张素转化酶抑制药不能耐受患者,应用坎地沙坦联合卡维地洛治疗高血压的降压效果、安全性与逆转高血压心肌肥厚和改善心功能的疗效。方法:将119例原发性高血压并左室肥厚患者随机分为坎地沙坦+卡维地洛组(A组)和吲哒帕胺+卡维地洛组(B组),观察血压、不良反应,并作多普勒超声心动图检测。结果:①2组治疗12个月后,收缩压与舒张压均有明显下降[155/98mmHg(1mmHg=0.133kPa)至137/85mmHg;157/101mmHg至140/88mmHg,均P<0.01]。②A组治疗12个月后,左室舒张末期内径、左室后壁与舒张末期室间隔厚度较治疗前显著下降(P均<0.05),左室重量及左室重量指数下降更显著(P均<0.01);而在B组治疗12个月后左室后壁与室间隔厚度无明显变化,左室重量及左室重量指数有所下降(P<0.05)。③A组患者治疗后的心排血量、左室射血分数、舒张早期与舒张晚期峰值流速的比值、E峰减速度均不同程度得到改善,B组治疗前后差异无统计学意义。结论:原发性高血压患者经坎地沙坦加卡维地洛治疗12个月后,可使其左室肥厚显著逆转及左室功能显著改善。
Objective: To investigate the antihypertensive effect of candesartan combined with carvedilol in patients who can not tolerate angiotensin converting enzyme inhibitors, and to evaluate the safety and antihypertensive effect on cardiac hypertrophy and cardiac function. Methods: 119 patients with essential hypertension and left ventricular hypertrophy were randomly divided into candesartan + carvedilol group (group A) and indapamide + carvedilol group (group B), blood pressure , Adverse reactions, and for Doppler echocardiography. Results: After 12 months of treatment, the systolic and diastolic blood pressure were significantly decreased in group 2 [155 / 98mmHg (1mmHg = 0.133kPa) to 137/85mmHg and 157 / 101mmHg to 140 / 88mmHg, both P <0.01]. ②After 12 months of treatment, left ventricular end-diastolic diameter, left ventricular posterior wall and end-diastolic septal thickness were significantly lower than those before treatment (P <0.05), left ventricular mass and left ventricular mass index decreased more significantly (P <0.01). However, the thickness of left ventricular posterior wall and interventricular septum did not change significantly after 12 months of treatment in group B, and left ventricular mass and left ventricular mass index decreased (P <0.05). ③After treatment, cardiac output, left ventricular ejection fraction, early peak of diastolic and late peak diastolic velocity and E-peak deceleration of group A were all improved to some extent. There was no significant difference between the two groups before and after treatment. CONCLUSION: After 12 months of treatment with candesartan and carvedilol in patients with essential hypertension, left ventricular hypertrophy can be significantly reversed and left ventricular function can be significantly improved.