替米沙坦预防高血压并阵发性房颤患者房颤复发的效果及机制

摘要

Objective To investigate the effects and mechanism of telmisartan on prevention of atrial fibrillation recurrence in hypertensive patients with paroxysmal atrial fibrillation. Methods A total of 186 hypertensive patients with paroxysmal atrial fibrillation were randomly divided into the observation group ( n = 91 ) and the control group ( n = 95 ), all the patients were treated with amiedarone and telmisartan 20-80 mg/d were administered simultaneously in the observation group, course of the treatment was six months; patients were given calcium antagonists, beta-blockers or diuretics as additional treatment if their blood pressures were not well controlled, while patients of the control group did not receive antihypertensive drugs including angiotensin converting enzyme inhibitors and angiotensin receptor blockers. During the follow-up time, changes of blood pressure, numbers of cases of atrial fibrillation recurrence, episodes of atrial fibrillation, time of the first atrial fibrillation recurrence and changes of left ventricular end diastolic dimension(LVEDD) and left atrial dimension (LAD) were recorded. Results There were no significant differences in blood pressure between two groups; there was more prolonged first recurrence time, less episodes of atrial fibrillation and numbers of cases of atrial fibrillation recurrence in the observation group compared to those of the control group; LVEDD and LAD of the observation group significantly reduced compared with those of the control group at the end of 6 months( P ＜ 0.05). Conclusions Telmisartan can prevent atrial fibrillation recurrence in the hypertensive patients with paroxysmal atrial fibrillation, the meeharism may be inhibition of atrial remodeling.%目的 探讨替米沙坦预防高血压病并阵发性房颤患者房颤复发的效果及其作用机制.方法 将186例高血压并阵发性房颤患者随机分为观察组91例和对照组95例,两组均口服胺碘酮,在此基础上观察组同时口服替米沙坦20～80 mg/d,均连续治疗 6个月;两组血压控制不理想者均联用钙离子拮抗剂、β受体阻滞剂与利尿剂,但对照组停用和避免使用血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂.随访6个月分别观察两组血压变化,房颤复发例数、发作次数、首次复发时间及左室舒张末内径(LVEDD)、左房内径(LAD)变化.结果 两者治疗前后血压变化无显著差异;观察组6个月末房颤复发例数与次数均显著低于对照组、首次复发时间明显长于对照组;观察组6个月末LVEDD、LAD均显著小于对照组(P＜0.05).结论 替米沙坦可预防高血压病并阵发性房颤患者房颤复发,机制主要是抑制心房重构.