Effect of Telmisartan on the Regression of the Left Ventricular Hypertrophy in the Patients of Essential Hypertension
Effect of Telmisartan on the Regression of the Left Ventricular Hypertrophy in the Patients of Essential Hypertension
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DOI：
10.7860/jcdr/2013/5416.3127
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发表时间：
2013-07-01
影响因子：
0.2
通讯作者：
Ramani, Y. Roja
中科院分区：
文献类型：
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作者：
Misra, Kumar Haraprasad;Das, Mangala Charana;Ramani, Y. Roja
简介：由于肌肉肥大导致的左心室质量增加已成为心血管死亡率和发病率的一个强有力的压力非依赖性风险因素。它与死亡风险相关，是单独与高血压相关的风险的3倍。对于左心室肥大（LVH）的发展，除了压力和/或容量超负荷的慢性增加之外，血浆ACE活性、血浆醛固酮水平和血管紧张素-II浓度的升高起主要作用。本研究比较选择性血管紧张素Ⅱ受体阻滞剂替米沙坦和选择性β 1肾上腺素受体阻滞剂阿替洛尔对原发性高血压患者LVH的逆转作用。本研究在两组高血压伴LVH患者中进行：第1组：服用替米沙坦80 mg OD的患者，第2组：服用阿替洛尔50 mg OD的患者。在治疗前和治疗后6个月，在印度布拉马普尔MKCG医学院医院心脏病科测量两组的血压并进行超声心动图检查。结果：在阿替洛尔组，左心室质量指数（LVMI）是LVH的更好指标，其平均值从143.93 +/- 2.44 gm/m2变为130.16 +/- 2.88 gm/m2（t= 5.83，p< 0.01）。在替米沙坦组，平均值从184.67 +/- 7.14 gm/m2变为133.41 +/- 4.24 gm/m2（t= 12.12，p< 0.001，与基线相比）。在比较替米沙坦与阿替洛尔时，发现替米沙坦的降幅（27.49%）大于阿替洛尔（9.68%）。在替米沙坦组中，26例患者中有13例达到LVMI目标值，男性< 134 gm/m2，女性< 110 gm/m2（50%）。结论：替米沙坦是一种选择性的血管紧张素Ⅱ受体拮抗剂，其降压作用不局限于阻断血管紧张素Ⅱ受体（AT 1），而可能是通过阻断血管紧张素Ⅱ受体而减弱其促生长作用。从这项研究中，很明显，替米沙坦在实现LVH消退方面上级阿替洛尔，LVH是心血管发病率和死亡率的更好指标。
Introduction: An increase in the Left Ventricular Mass as a result of muscle hypertrophy, has emerged as a powerful pressure independent risk factor for the cardiovascular mortality and morbidity. It is associated with a risk of death that is 3 times greater than the risk which is associated with hypertension alone. For the development of Left Ventricular Hypertrophy (LVH), in addition to a chronic increase in the pressure and/or volume overload, an elevation in the plasma ACE activity, plasma aldosterone levels, and the angiotensin-II concentrations play a major role. In this study, the effect of Telmisartan, a selective angiotension-II receptor blocker, was compared with that of Atenolol, a selective beta(1) adrenergic receptor blocker, on the regression of LVH in the patients of essential hypertension.Material and Method: Essential hypertensive patients with LVH were selected for this study, as per the inclusion and exclusion criteria. This study was carried out on two groups of hypertensive patients with LVH:Group-1 : The patients who were taking telmisartan 80 mg OD.Group-2 : The patients who were taking atenolol 50 mg OD. The blood pressure was measured and echocardiography was done in both the groups, prior to the treatment and 6 months after the treatment in the Department of Cardiology, MKCG Medical College Hospital, Brahmapur, India. The data were analysed by using the Student's 't' test.Results: In the cases of Left Ventricular Mass Index (LVMI), which is a better indicator of LVH, in the Atenolol group, the mean value changed from 143.93 +/- 2.44 gm/m2 to 130.16 +/- 2.88 gm/m(2) (t= 5.83, p< 0.01 versus baseline). In the Telmisartan group, the mean value changed from 184.67 +/- 7.14 gm/m(2) to 133.41 +/- 4.24 gm/m(2) (t= 12.12, p< 0.001 versus baseline). On comparing Telmisartan with Atenolol, Telmisartan was found to produce a greater (27.49%) reduction than Atenolol (9.68%). In the Telmisartan group, 13 patients out of 26 patients achieved a target value of LVMI that was < 134 gm/m(2) in males and < 110 gm/m(2) in females (50%). In the Atenolol group, only 9 patients out of 22 patients achieved a target value (40.90%).Conclusion: Thus, Telmisartan a selective AT1 antagonist, possesses pharmacological effects beyond a blood pressure reduction in which the blockade of the AT1 receptor may lead to attenuation of the growth promoting action of Ang II. From this study, it is clear that Telmisartan is superior to Atenolol in achieving a regression of LVH, which is a better indicator of the cardiovascular morbidity and mortality.