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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。
Objective To investigate the effect of long-term hydrochlorothiazide (HCTZ) combined with spironolactone or captopril on left ventricular mass parameters in patients with essential hypertension. Methods A multicenter randomized double-blind study was designed. Select 9 Kailuan Mining Hospital, screening out mild to moderate hypertension patients. The patients were randomly divided into spironolactone group (HCTZ 12.5 mg once a day, spironolactone 20 mg once a day, n = 112) and captopril group (HCTZ 12.5 mg once a day for 2 weeks) / d + captopril 25 mg twice daily, n = 109). A total of 36 months medication. During the treatment period, follow-up 1, monitoring blood pressure. Echocardiography and LVMI or LVMIh were performed at the end of elution and at the end of the 12th, 24th and 36th months of treatment. Blood samples were collected for biochemical tests. Results (1) At the end of 12 months, LVMI in both groups decreased significantly (-8.9% in spironolactone group, P <0.05; -12.6% in captopril group, P <0.01) The LVMI was further decreased in the group of patients (spironolactone: -8.9% vs-17.5%, P <0.05; -12.6% vs -19.2%, P> 0.05) There was no significant difference between the two groups (P> 0.05); 2) The blood pressure of two groups decreased significantly at the end of 12, 24 and 36 months (P <0.01), but there was no significant difference between the two groups ). Conclusions Both HCTZ and spironolactone or captopril can effectively reduce blood pressure and LVMI or LVMIh, and the effect is more obvious with the prolongation of treatment time.