This study investigated the effects of a low-dose fixed combination of the ACE inhibitor isradipine SRO (slow-release oral) and the calcium antagonist spirapril on left ventricular hypertrophy (LVH) in patients with mild to moderate hypertension and LVH. Open, non-randomised preliminary study. 20 patients (11 men and nine women, mean age 62 ± 12 years) with arterial hypertension and LVH were included in the study. ECG-triggered nuclear magnetic resonance tomography (MRT), echocardiography and radionuclide ventriculography were used to measure parameters of left ventricular function at baseline and after 12 weeks’ treatment with a fixed combination of isradipine SRO 2.5mg and spirapril 3mg once daily. Diastolic blood pressure was normalised (≤90mm Hg) after 6 weeks in 19 of 20 patients; only one patient required the dosage to be doubled to achieve BP control. Mean blood pressure was reduced from 163/99mm Hg at baseline to 150/84mm Hg at the end of the study (2p < 0.001). Mean end-systolic interventricular septum thickness measured by MRT was reduced from 20.1 to 18.2mm (2p < 0.001) after 12 weeks and end-systolic left ventricular posterior wall thickness from 19.2 to 17.7mm (2p < 0.001). Echocardiographic assessments resulted in similar findings. The left ventricular mass index calculated from echocardiographic data decreased from 195 to 164 g/m2 (2p < 0.001). A marked drop in total peripheral resistance from 1470 to 1233 units (2p < 0.001) was paralleled by a 14% decrease in systolic wall tension and an improvement in peak ventricular filling rate. Although there was a significant reduction in left ventricular mass, parameters of cardiac work did not change significantly, thus indicating a more efficient ventricular performance during treatment. In this preliminary study, a low-dose combination of isradipine and spirapril induced a significant regression in LVH and an improvement in haemodynamic parameters in patients with mild to moderate hypertension and LVH. This finding needs to be confirmed in larger-scale, controlled studies.
本研究探讨了 ACE
抑制剂异拉地平 SRO(缓释口服)和
钙拮抗剂
螺普利的低剂量固定组合对轻中度高血压和左心室肥厚患者左心室肥厚(LVH)的影响。开放性、非随机初步研究。20 名动脉性高血压和左心室肥厚患者(男性 11 人,女性 9 人,平均年龄 62 ± 12 岁)参与了这项研究。采用心电图触发核磁共振断层扫描(MRT)、超声心动图和放射性核素心室造影术,测量基线时和每日一次服用异拉地平 SRO 2.5 毫克和
螺普利 3 毫克固定组合药物 12 周后的左心室功能参数。20 名患者中有 19 名在 6 周后舒张压恢复正常(≤90 毫米
汞柱);只有一名患者需要加倍剂量才能达到血压控制目标。平均血压从基线时的 163/99mm Hg 降至研究结束时的 150/84mm Hg(2p < 0.001)。通过 MRT 测量的收缩末期平均室间隔厚度在 12 周后从 20.1 毫米降至 18.2 毫米(2p < 0.001),收缩末期左心室后壁厚度从 19.2 毫米降至 17.7 毫米(2p < 0.001)。超声心动图评估也得出了类似的结果。根据超声心动图数据计算得出的左心室质量指数从 195 g/m2 降至 164 g/m2 (2p < 0.001)。总外周阻力从 1470 单位显著下降到 1233 单位(2p < 0.001),与此同时,收缩期室壁张力下降了 14%,心室充盈率峰值也有所改善。虽然左心室质量明显降低,但心脏做功参数并无明显变化,这表明在治疗期间心室性能更有效。在这项初步研究中,小剂量联合使用异拉地平和
螺普利可使轻中度高血压和左心室肥厚患者的左心室肥厚明显减轻,血流动力学参数得到改善。这一发现需要在更大规模的对照研究中得到证实。