【摘要】 目的对“1999WHO/ISH高血压防治指南”危险分层为高危和极高危组的患者单用或联合使用指南推荐的一线降压药,以血压<140/90mmHg作为目标血压,观察有效控制血压对高危高血压患者左室肥厚的长期影响。方法763例患者确定危险分层入选后,随机进入目标治疗组(n=382)和对照组(n=381)。目标治疗组在高血压专科门诊定期随访,按5步法治疗方案,直到达到或接近目标血压为止。对照组在普通门诊治疗。测定基线和治疗后的超声心动图。结果两组患者的基线特征无明显差异。在平均4.4年随访期间,目标治疗组平均收缩压/舒张压为(133.8±6.6/79.7±5.5)mmHg,明显低于对照组(151.7±12.7/87.7±8.0)mmHg,P<0.0001)。共有437例患者复查超声心动图1次以上。目标治疗组(n=270)左室重量指数由124.9降至119.7g/m2,下降4.2%(P=0.007);对照组由131.0增至136.9g/m2,增加4.5%(P=0.05)。233例患者在基线时患有左室肥厚,目标治疗组142例;对照组91例。最后1次测量与基线相比,目标治疗组左室重量指数降低14.8g/m2(10.1%,P<0.0001);对照组下降2.9g/m2(1.8%,P=0.53)。目标治疗组66例左室肥厚消失,左心室肥厚逆转率为46.5%,显著高于对照组的31.9%(91例中29例左室肥厚消失,P=0.03)。在基线没有左室肥厚的204例患者中,目标治疗组(n=128)左室重量指数增加5.3g/m2(5.3%,P=0.03);对照组(n=76)增加16.4g/m2(16.8%,P<0.0001)。复查达到左室肥厚标准者,目标治疗组34例(26.6%);对照组27例(35.5%),两组间无显著差异(P=0.12)。结论与一般治疗相比,长期严格控制血压能降低高血压左室肥厚患者的左心室重量,并显著提高左室肥厚逆转率。更多还原

【Abstract】 ObjectiveWe investigated the effect of long-term intensive blood pressure (BP) control (<140/90 {mm Hg}) regimen on LVH versus routine antihypertensive therapy in hypertensive patients at high or very high risk. MethodsIn the 763 randomized patients, 382 were allocated to intensive BP control(group Ⅰ) and 381 to routine therapy(group R).Echocardiography was carried out to measure left ventricular mass index(LVMI) at baseline and follow-up in 437 patients.ResultsAt baseline, characteristics of the participants in the 2 groups were similar.In a mean follow-up of 4 years, in group Ⅰ SBP/DBP was decreased to (133.8±6.6/79.7±5.5)mm Hg, significantly lower than in the group R [(151.7±12.7/87.7±8.0)mm Hg, P<0.0001].In patients who had echocardiographic measurement at least once in the whole follow-up period, LVMI decreased from 124.9 to 119.7 g/m~ 2 (-4.2%, P=0.007) in group Ⅰ(n=270), whereas LVMI was increased in group R from 131.0 to 136 g/m~2(+4.5%, P=0.05).Among 233 patients who had LVH at baseline, intensive treatment resulted in decreased in LVMI (n=142, -14.8 g/m~2 , -10.1%, P<0.0001), with no change in LVMI in group R(n=91, -2.9 g/m~2, -1.8%, P=0.53, n=91).204 patients had no LVH at baseline, at the end of the study,LVMI was increased by 5.3 g/m~2 (5.3%, P=0.03) with the incidence of occurrence of LVH being 26.6% in group Ⅰ(n=128) without difference compared with group R of 35.5%(P=0.12). ConclusionOur study demonstrated that long-term intensive BP control decreased left ventricular mass and led to regression of left ventricular hypertrophy in high risk hypertensive patients.更多还原