替米沙坦对老年高血压患者血压晨峰与心脏重构的影响.docVIP

替米沙坦对老年高血压患者血压晨峰与心脏重构的影响 　　作者：周咏梅，陶剑虹 作者单位：四川省人民医院心内科，四川 成都　610072 　　【摘要】 目的：探讨替米沙坦对老年高血压患者血压晨峰现象及心脏重构的影响。方法： 120例老年高血压患者根据血压晨峰是否超过23.58mmHg分为晨峰组(60例)与非晨峰组(60例)，均予以替米沙坦80～160mg/d治疗6月，治疗前后行动态血压、心脏超声检查。结果：与血压非晨峰组比较，晨峰组左室肥厚发生率(36.7%比51.6%)、左房内径扩大率 (26.7%比41.7%)明显升高(P均0.01);与治疗前比较，晨峰组经替米沙坦治疗6月后收缩压(SBP)差值[(32.7±4.2)mmHg比(21.2±6.7) mmHg]、舒张压(DBP)差值[(20.3±3.6)mmHg比(13.5±7.4) mmHg]明显降低(P0.01)，而非晨峰组SBP、DBP差值较治疗前无明显降低(P0.05)，两组替米沙坦治疗6月后左室重量指数均明显降低(P0.05)。结论：老年高血压患者血压晨峰程度与心脏重构密切相关，替米沙坦能有效控制老年高血压患者晨峰现象，逆转左室肥厚。 　　【关键词】 替米沙坦,高血压,心室重构,老年人 　　Abstract：Objective： To investigate influence of telmisartan on morning peak of blood pressure and cardiac remodeling in aged patients with hypertension. Methods：According to morning peak of blood pressure≥23.58 mmHg or not，a total of 120 aged patients with hypertension were divided into morning peak of blood pressure group (observe group，n=60) and non-morning peak of blood pressure group (control group，n=60). Both groups received telmisartan 80～160 mg/d for six months and underwent ambulatory blood pressure monitoring and echocardiography examination before and after treatment. Results： Compared with control group，incidence rates of left ventricular hypertrophy (36.7% vs. 51.6%) and left atrial enlargement rate (26.7% vs. 41.7%) significantly increased in observe group，P0.01 both;compared with before treatment，after six-month telmisartan treatment，there were significant decrease in differences of systolic blood pressure (SBP) [(32.7±4.2) mmHg vs. (21.2±6.7) mmHg]and diastolic blood pressure (DBP) [(20.3±3.6) mmHg vs. (13.5±7.4) mmHg]in observe group (P0.01 both)，but there were no significant decrease in SBP and DBP in control group(P0.05). After six-month telmisartan treatment，left ventricular mass indexes of the two groups significantly decreased (P0.05). Conclusion：Morning peak of blood pressure is closely correlated with cardiac remodeling in aged patients with hypertension. Telmisartan can reverse left ventricular hypertrophy，ef