【摘要】 目的探讨氢氯噻嗪(HCTZ)与螺内酯或卡托普利长期联用对高血压病患者左室质量参数的影响。方法采用多中心随机双盲研究设计。选择9所开滦矿区医院,筛选出轻、中度高血压病患者。人选患者经安慰剂洗脱2周后随机分为螺内酯组(HCTZ 12.5 mg,1次/d+螺内酯20 mg,1次/d,n=112)和卡托普利组(HCTZ 12.5mg,1次/d+卡托普利25 mg,2次/d,n=109)。共服药36月。治疗期间每月随访1次,监测血压。洗脱期末和治疗12、24、36月末行超声心动图检查并计算左室质量指数(LVMI 或 LVMIh),采静脉血进行生化检查。结果 1)治疗12个月末,两组患者的 LVMI 均较治疗前显著下降(螺内酯组-8.9%,P<0.05;卡托普利组-12.6%,P<0.01);随治疗时间延长,两组患者的 LVMI 进一步下降(36月末与12月末比较,螺内酯组:-8.9%vs-17.5%,P<0.05;卡托普利组:-12.6%vs-19.2%,P>0.05),下降幅度组间比较无统计学意义(P>0.05);2)治疗12、24、36月末两组患者血压均显著下降(P<0.01),下降幅度组间比较,差异无统计学意义(P>0.05)。结论 HCTZ与螺内酯或卡托普利联用均能有效降低血压和 LVMI 或 LVMIh,且随治疗时间延长疗效更为显著。更多还原

【Abstract】 Objective To explore the effects of long-term treatment with HCTZ combined spironolaetone or captopril on left ventricular hypertrophy in hypertensive patients.Methods A multicentres,double-blind,ran- domized study was carried out in 9 hospitals.After 2-weeks’ washout,the eligible patients with mild-to-moderate hypertension were randomly to receive spironolactone (HCTZ 12.5 mg qd+spironolactone 20 mg qd,n=112) or captopril (HCTZ 12.5 mg qd+captopril 25 mg hid,n=109) for 36 months.At the end of washouting period,12, 24,36 months,all subjects underwent echocardiographic study.Left ventricular mass index (LVMI or LVMIh) were determined by echocardiography.Results 1) After 12 months’ treatment,both spironolactone/HCTZ and captopril/HCTZ significantly reduced LVMI (spironolactone/HCTZ:-8.9%,P<0.05;captopril/HCTZ:- 12.60%,P<0.01),more significant reduction of LVMI by both combined treatments were shown with the extention of treatment from 12 months to 36 months (36 months vs 12 months,spironolactone/HCTZ:-8.9% vs-17.5%, P<0.05;captopril/HCTZ:-12.6 % vs-19.2%,P>0.05),with no differences between two combinations groups (P>0.05);2)After 12,24,36 months’ treatment,BP was decreased significantly in each group (P<0.01, respectively),no siginificant intergroup differences were found (P>0.05).Conclusion Both combined spirono- lactone/HCTZ and captopril/HCTZ significantly reduced BP and LVMI or LVMI and the maguitude of reduction was further enhanced after prolonged treatment.更多还原