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Received:September 19, 2022 Published Online:June 20, 2023
Received:September 19, 2022 Published Online:June 20, 2023
中文摘要: 目的 对比沙库巴曲缬沙坦对高血压合并左房内径（LAD）增大患者及LAD正常高血压患者的降压临床疗效。 方法 入选2021年6月至2022年1月在南京市第一医院诊断为原发性高血压的80例患者，且近2周未服用降压药，依据LAD大小分为第一组（LAD≥40 mm，50例）和第二组（LAD＜40 mm，30例）。所有患者入组后给予沙库巴曲缬沙坦每天服用100 mg，若1周后血压达标（即收缩压＜140 mmHg且舒张压＜90 mmHg）,继续使用100 mg，若未达标，加量至每天200 mg；2周后若血压达标,继续使用200 mg，若仍未达标，可依据患者个体化情况加至每天400 mg或加用其他种类降压药；观察至4周（第28天），比较两组患者的血压水平的变化及血压达标率。 结果 与基线血压水平相比，第一组第7天收缩压的下降值［(11.06±1.36) mmHg vs (7.53±1.31) mmHg, P＜0.01］以及舒张压的下降值［(5.76±2.63) mmHg vs (4.47±1.31) mmHg, P=0.014］，第14天收缩压的下降值［(19.70±2.62) mmHg vs(13.80±1.92) mmHg, P＜0.01］以及舒张压的下降数值［(10.02±3.17) mmHg vs (8.23±2.84) mmHg, P=0.013］均高于第二组，差异具有统计学意义。4周后，两组患者的收缩压、舒张压水平以及联合使用降压药物的比例分布差异均无统计学意义（P＞0.05）。 结论 相较于LAD正常的高血压患者，沙库巴曲缬沙坦对合并LAD增大的患者降压疗效更加优越，并且在使用后的前两周降压幅度非常明显。
Abstract:Objective To observe the difference of hypotensive effect of sarcubitril/valsartan between hypertensive patients with increased left atrial diameter (LAD) and with normal LAD. Methods A total of 80 patients who were diagnosed as essential hypertension in Nanjing First Hospital from June 2021 to January 2022 were selected, and they all did not take antihypertensive drugs in the past two weeks. According to the size of LAD, they were divided into first group (LAD≥40 mm, n=50) and second group (LAD＜40 mm, n=30) . After enrollment, all patients were given a daily dose of 100 mg of sarcubitril/valsartan. If the blood pressure reached the standard after 1 week［systolic blood pressure (SBP) ＜140 mmHg and diastolic blood pressure (DBP) ＜90 mmHg］, continue to use 100 mg of sarcubitril/valsartan. If not, increase the dose to 200 mg of sarcubitril/valsartan per day. If the blood pressure reaches the standard after 2 weeks, continue to use 200 mg dose. If the blood pressure does not reach the standard, add it to 400 mg dose per day or add other kinds of antihypertensive drugs according to the patient's individualized situation. The changes of blood pressure level and the rate of reaching the standard of blood pressure in the two groups for 4 weeks (28th day) were observed and compared. Results Compared with second group, the decrease of SBP ［7th day: (11.06±1.36) mmHg vs (7.53±1.31) mmHg, P＜0.01; 14th day: (19.70±2.62) mmHg vs (13.80±1.92) mmHg, P＜0.01］ and the decrease of DBP ［7th day: (5.76±2.63) mmHg vs (4.47±1.31) mmHg, P=0.014; 14th day: (10.02±3.17) mmHg vs (8.23±2.84) mmHg, P=0.013］ were significant higher in the first group. After four weeks, there was no significant difference in SBP, DBP levels and the distribution of proportion of combined use of antihypertensive drugs between the two groups (P＞0.05) . Conclusion Compared with hypertensive patients with normal LAD, sarcubitril/valsartan has a better effect on blood pressure reduction in patients with increased LAD is more superior, and the blood pressure reduction range is very obvious in the first two weeks after use.
keywords: Sarcubitril / valsartan Hypertension Left atrial diameter Atrial remodeling Antihypertension Systolic blood pressure Diastolic blood pressure
文章编号： 中图分类号：R544.1 文献标志码：B
基金项目:中国心血管健康联盟-诺·创高血压科研创新基金 (2021-CCA-HTN-60)
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