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目的对“1999WHO/ISH高血压防治指南”危险分层为高危和极高危组的患者单用或联合使用指南推荐的一线降压药,以血压<140/90mmHg作为目标血压,观察有效控制血压对高危高血压患者左室肥厚的长期影响。方法763例患者确定危险分层入选后,随机进入目标治疗组(n=382)和对照组(n=381)。目标治疗组在高血压专科门诊定期随访,按5步法治疗方案,直到达到或接近目标血压为止。对照组在普通门诊治疗。测定基线和治疗后的超声心动图。结果两组患者的基线特征无明显差异。在平均4.4年随访期间,目标治疗组平均收缩压/舒张压为(133.8±6.6/79.7±5.5)mmHg,明显低于对照组(151.7±12.7/87.7±8.0)mmHg,P<0.0001)。共有437例患者复查超声心动图1次以上。目标治疗组(n=270)左室重量指数由124.9降至119.7g/m2,下降4.2%(P=0.007);对照组由131.0增至136.9g/m2,增加4.5%(P=0.05)。233例患者在基线时患有左室肥厚,目标治疗组142例;对照组91例。最后1次测量与基线相比,目标治疗组左室重量指数降低14.8g/m2(10.1%,P<0.0001);对照组下降2.9g/m2(1.8%,P=0.53)。目标治疗组66例左室肥厚消失,左心室肥厚逆转率为46.5%,显著高于对照组的31.9%(91例中29例左室肥厚消失,P=0.03)。在基线没有左室肥厚的204例患者中,目标治疗组(n=128)左室重量指数增加5.3g/m2(5.3%,P=0.03);对照组(n=76)增加16.4g/m2(16.8%,P<0.0001)。复查达到左室肥厚标准者,目标治疗组34例(26.6%);对照组27例(35.5%),两组间无显著差异(P=0.12)。结论与一般治疗相比,长期严格控制血压能降低高血压左室肥厚患者的左心室重量,并显著提高左室肥厚逆转率。
Objective To investigate the effective control of blood pressure by taking the blood pressure <140 / 90mmHg as the target blood pressure for the first-line antihypertensive drugs recommended by the guidelines for patients with high-risk and very high-risk groups in the 1999 WHO / ISH Guidelines for Prevention and Treatment of Hypertension. Long-term effects of left ventricular hypertrophy in high-risk hypertensive patients. Methods Totally 763 patients were randomly assigned to the target treatment group (n = 382) and the control group (n = 381) after stratification was selected. The target treatment group was regularly followed up in hypertensive specialist clinics until the target blood pressure reached or approached at the 5-step regimen. Control group in general out-patient treatment. Baseline and post-treatment echocardiography were measured. Results There was no significant difference in baseline characteristics between the two groups. During an average follow-up of 4.4 years, the mean systolic / diastolic blood pressure of the target treatment group was (133.8 ± 6.6 / 79.7 ± 5.5) mmHg, significantly lower than that of the control group (151.7 ± 12.7 / 87.7 ± 8.0) mmHg, P <0.0001). A total of 437 patients reviewed echocardiography more than once. In the target treatment group, the left ventricular mass index decreased from 124.9 to 119.7g / m2, a decrease of 4.2% (P = 0.007); the control group increased from 131.0 to 136.9g / m2 with a 4.5% increase (P = 0.05). 233 patients had left ventricular hypertrophy at baseline, 142 in the target treatment group and 91 in the control group. In the last measurement, the left ventricular mass index decreased by 14.8 g / m2 (10.1%, P <0.0001) in the target group and 2.9 g / m2 (1.8%, P = 0.53) in the control group as compared with baseline. The left ventricular hypertrophy disappeared in 66 patients in the target treatment group, and the rate of left ventricular hypertrophy was reversed in 46.5%, which was significantly higher than that in the control group (29% of 91 cases, left ventricular hypertrophy disappeared, P = 0.03). Among the 204 patients without left ventricular hypertrophy at baseline, left ventricular mass index increased 5.3 g / m 2 (5.3%, P = 0.03) in the target treatment group (n = 128) and 16.4 g / m 2 in the control group (n = 76) (16.8%, P <0.0001). Reexamination of patients with LVH, the target treatment group 34 cases (26.6%); control group 27 cases (35.5%), no significant difference between the two groups (P = 0.12). CONCLUSION: Long-term, strict blood pressure control can reduce left ventricular mass in hypertensive left ventricular hypertrophy patients and significantly increase the rate of left ventricular hypertrophy reversal compared with general treatment.