Objective To evaluate the clinical curative effect and safety of angiotensin Ⅱ receptor antagonist(ARB),β1 receptor blockers combined with aldosterone antagonists (three drug regimen) and ARB,β1 receptor blockers(two drug regimen) in the treatment of patients with hypertension secondary to left ventricular diastolic dysfunction.Methods Totally 249 cases of hypertension secondary to left ventricular diastolic dysfunction were recruited from October 2010 to April 2012 and were divided into the observation group(121 cases) and control group(128 cases).Patients in the control group were given ARB + β1 receptor blockers (two drug regimen) and patients in the observation group were given ARB + β1 receptor blockers + aldosterone antagonists(three drug regimen).All of the patients were treated and followed up for 24-month.Changes of 2 groups of blood pressure,left ventricular function,brain natriuretic peptide(BNP) were analyzed.Results The serum BNP of 2 groups after treatment was lower than that before treatment [the observation group:(128 ± 25)ng/L vs (204 ± 34)ng/L,the control group:(156 ± 27) ng/L vs (200 ± 33) ng/L,P ＜ 0.05],but serum BNP was much lower in the observation group than that in control group after treatment(P ＜ 0.05).The blood pressure of 2 groups after treatment was lower than that before treatment; left ventricular ejection fraction and mitral early diastolic velocity/late diastole blood flow velocity were higher than those before treatment [systolic pressure:(139 ± 16) mmHg (1 mmHg =0.133 kPa)vs (163±25)mmHg,(137±17)mmHgvs (162±25)mmHg; diastolic pressure:(89±14)mmHg vs (98 ± 19) mmHg,(89 ± 13) mmHg vs (98 ± 20) mmHg ; left ventricular ejection fraction:(58 ± 5) ％ vs (53 ± 4) ％,(52 ± 5) ％ vs (46 ± 5) ％ ; mitral early diastolic velocity/late diastole blood flow velocity:(1.34 ± 0.68) vs (0.68 ± 0.23),(1.06 ± 0.55) vs (0.71 ± 0.21),all P ＜ 0.05].The blood pressure was significantly decreased; left ventricular ejection fraction and mitral early diastolic velocity/late diastole blood flow velocity were significantly improved in both groups(P ＜ 0.05).Twenty-one and forty-four cases of heart failure were observed in the observation and control group and demonstrated the higher risk in control group(hazard ratio =0.41,95％ confidence interval:0.25-0.66,P ＜ 0.01).Conclusion These drug regimes have the clinical efficacy in the treatment of hypertension secondary to left ventricular diastolic dysfunction,but the three drug regiment can significantly decrease the risk of developing heart failure.%目的 探讨血管紧张素Ⅱ受体拮抗剂(ARB)联合β1受体阻滞剂方案与ARB、β1受体阻滞剂联合醛固酮拮抗剂方案在控制高血压继发左心室舒张功能不全患者血压及心力衰竭风险方面的差异.方法 选取2010年10月至2012年4月航天中心医院门诊及住院的高血压继发左心室舒张功能不全患者249例,采用随机数字表法分为观察组(121例)和对照组(128例).对照组给予ARB联合β1受体阻滞剂方案,观察组在对照组的基础上加用醛固酮拮抗剂.2组患者均治疗24个月.分析2组血压、左心室功能、脑钠肽等的变化.结果 入组前和治疗24个月后,观察组患者血清脑钠肽分别为(204±34)、(128±25) ng/L,对照组分别为(200 ±33)、(156±27) ng/L.2组患者治疗后血清脑钠肽均较本组治疗前明显降低,治疗前后差异均有统计学意义(P＜0.05);观察组治疗后血清脑钠肽明显低于对照组治疗后,组问差异有统计学意义(P＜0.05).观察组和对照组患者治疗后血压较本组治疗前明显下降,左心室射血分数、二尖瓣舒张早期最大血流速度/舒张晚期最大血流速度比值较本组治疗前明显提高,治疗前后差异均有统计学意义[收缩压:(139±16) mmHg(l mmHg=0.133 kPa)比(163±25) mmHg,(137±17) mmHg比(162±25) mmHg;舒张压:(89±14) mmHg比(98±19) mmHg,(89 ± 13) mmHg比(98±20) mmHg;左心室射血分数:(58±5)％比(53±4)％,(52±5)％比(46±5)％;二尖瓣舒张早期最大血流速度/舒张晚期最大血流速度比值:(1.34±0.68)比(0.68±0.23),(1.06±0.55)比(0.71±0.21),均P＜0.05].观察组治疗后血压下降、左心室射血分数及二尖瓣舒张早期最大血流速度/舒张晚期最大血流速度比值的改善明显优于对照组,组间差异有统计学意义(P＜0.05).观察组和对照组累计发生心力衰竭例数分别为21例和44例,对照组治疗期间发生心力衰竭风险明显高于观察组(风险比=0.41,95％置信区间:0.25 ～ 0.66,P＜0.01).结论 ARB联合β1受体阻滞剂方案与ARB、β1受体阻滞剂联合醛固酮拮抗剂方案对高血压继发左心室舒张功能不全患者均有一定临床疗效,但ARB、β1受体阻滞剂联合醛固酮拮抗剂方案可明显降低治疗期间心力衰竭发生风险.
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