【作者】 李静；

【导师】 张瑞云；

【作者基本信息】 昆明医学院 ， 内科学， 2003， 硕士

【摘要】 目的：观察Losartan(商品名科素亚)对原发性高血压(EH)患者血压(BP)及左室肥厚(LVH)、左室功能的影响。方法：轻、中度EH 34例，口服科素亚50mg／日，疗程4周。治疗前后测诊室坐位收缩压／舒张压(SiSBP／SiDBP)及心率(HR)；用超声心动图(UCG)测定心脏结构、左室功能、左室重量(LVM)、左室重量指数(LVMI)的变化；用动态血压监测(ABPM)观察血压、血压负荷(BPL)及血压变异(BPV)、谷／峰比率(T／P)。治疗前后测定血脂、空腹血糖、血尿酸、肾功能等。结果：治疗4周末，SiSBP／SiDBP显著下降(21.25±10.48)／(15.44±9.76)mmHg(1mmHg=0.1333kpa)，P＜0.001，降压总有效率96.87％；24小时及日间、夜间平均收缩压(SBP)、舒张压(DBP)、平均压(MAP)均降低，P＜0.001；血压负荷(BPL)明显减小，P＜0.001；血压变异(BPV)减小，P＜0.05；心输出量及心率无改变而左房(LA)、左室舒张末径(LVIDd)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、LVM、LVMI均下降，P＜0.001～0.01：射血分数增加(P＜0.05)及舒张早期充盈血量增加(P＜0.001～0.05)，等容舒张时间缩短(P＜0.001)。治疗后血尿酸减少(尸<0.001)而不影响空腹血糖、血脂、肌醉、尿素氮等。结论:科素亚治疗轻、中度EH，能在24小时内有效地、平稳地降低血压，并能改善LVH、改善左室舒张功能、降低血尿酸，耐受性好，基本无副作用。更多还原

【Abstract】 Objects: To investigate the antihypertensive efficacy and the effects on left ventricular hypertrophy (LVH), and left ventricular function in patients with essential hypertension (EH). Methods: Thirty-four patients with mild to moderate EH were given Cozaar 50mg once daily for four weeks. Before and after the treatment, sitting systolic blood pressure (BP) and diastolic BP (SiSBP/SiDBP) heart rate (HR) were measured, Echocardiography was conducted to determine cardiac structure and function, left ventricular mass (LVM), LVM index (LVMI) and identical volume relax time (IVRT). Meanwhile, ambulatory blood pressure monitoring (ABPM) was applied to determine 24-hour, daytime and nighttime systolic BP (SBP), diastolic BP (DBP), mean arterial BP (MAP) , BP load (BPL), BP variability (BPV) , trough-to-peak ratio. Metabolic parameters such as blood lipid and fasting blood glucose, serum uric acid and renal function were measured before and after the treatment. Results: Four weeks treatment with Cozaar significantly decreased SiSBP/SiDBP, decreasing range of BP were (21.25±10.48)7 (15.44±9.67)mmHg, (1mmHg=0.1333Kpa), P<0.001, total effective rate was 96.87%. SBP, DBP and MAP during 24-hour, daytime and nighttime were reduced significantly, P<0.001, BPL(P<0.001), BPV( P<0.001) were reduced, T/P>50%. There was no significantly difference about HR and cardiac output, but left atrium diameter (LA), left ventricular diastolic diameter (LVIDd), interventricular septal thickness (IVST), left ventricular posterior wall thickness(LVPWT), LVM, LVMI were all reduced (P<0.001-0.01), ejection fraction (EF) was increased (P<0.05), diastolic prime blood filling was improved (P<0.001-0.05), IVRT was shortened from baseline (P<0.001). Blood uric acid was reduced after the treatment, but it had no effect on fasting blood glucose, blood lipid, serum creatinine, urea nitrogen before and after the treatment. Conclusion: In patients with mild to moderate essential hypertension, Cozaar can effectively and steadily reduce blood pressure during 24-hour, reverse LVH, improve left ventricular diastolic function, lower serum uric acid and be generally well tolerated and less adverse effects.更多还原