| Objective It is to evaluate the influence and safety of Losartan, a new angiotension antagonist, or combined with calcium channel blocker Amlodipine on blood pressure, left ventricular remodeling and left ventricular function in elderly patients with moderate to severe essential hypertension and left ventricular hypertrophy (LVH). Moreover, the aim is to find a kind of more ideal treatment to promote efficacy, protect target organs and reduce cardiovascular morbidity and mortality by comparing monotherapy with combination therapy. Methods 94 elderly hypertensive patients with LVH were divided into three groups: Losartan group (100mg.d-1), Amlodipine group (10mg.d-1), and Losartan plus Amlodipine group (Los 50mg+Aml 5mg. d-1). Three groups were all treated for 12 weeks. Casual blood pressure (CBPM), 24-hour ambulatory blood pressure (ABPM), heartrate (HR), parameters of left ventricular structure and biochemical parameters such as liver function, renal function, blood glucose, blood lipid, blood uric acid, and electrolytes were measured and evaluated before and after treatment. Interventricular septum thickness (IVSTd), left ventricular posterior wall thickness (PWTd) and index of left ventricular mass (LVMI) were assessed as measures of LVH, left ventricular ejection fraction (LVEF) and E/A ratio were assessed as measures of left ventricular systolic and diastolic function. Results (1) After treatment of 12 weeks, parameters of CBPM and ABPM were decreased significantly (all p<0.001), while HR did not change (all p>0.05) in all three groups. There was no difference of decreased blood pressure(p>0.05) and T/P ratio between Losartan group and Almodipine group. Combination group had better effects of decreasing blood pressure than the two monotherapy groups (all p<0.05). (2) The overall efficacy rate of Losartan group and Amlodipine group was 73.3% and 70.0%, respectively, and that of Los plus Ami group was 93.5%. No statistical significant difference was found between Losartan group and Amlodipine group (p>0.05),however, the overall efficacy rate of combination group was significantly higher than the two monotherapy groups (all p<0.05). (3) There was no significant change of left ventricular diastolic dimension (LVIDd), left ventricular systolic dimension (LVIDs) (all p>0.05), while IVSTd, PWTd, LVMI were significantly reduced in all three groups after treatment of 12 weeks (all p<0.001). No statistical difference of the reduced level was found between Losartan group and Amlodipine group (p>0.05), while the reduced level of combination group was significantly different from the two monotherapy groups (all p<0.05). (4) LVEF and E/A ratio were significantly improved in all three groups after 12-week treatment(all p<0.001). The improved level of LVEF and E/A ratio in Losartan group was similar to that in Amlodipine group (p>0.05), while the improved level of LVEF and E/A ratio in combination group were significantly higher than the two monotherapy groups (all p<0.05). (5) The adverse reaction rate of Losartan group and Amlodipine group was 10% and 9.7%, respectively, and the rate of combination group was 3.3%. No statistical difference of biochemical parameter wasobserved in all three groups after 12-week treatment (all p>0.05). Conclusion (1) Both Losartan (100mg.d-1) and Amlodipine (10mg.d-1) can significantly reduce the blood pressure, reverse LVH and improve left ventricular function, they have similar therapeutic effects in elderly patients with moderate to severe essential hypertension and LVH. (2) Losartan and Amlodipine have coordinate effects in steadily decreasing blood pressure, reversing LVH and improving left ventricular function through different mechanisms. Moreover, combination therapy has more advantages of therapeutic effects than monotherapy. (3) It seems that Losartan and Amlodipine don't affect HR and metabolic factors, and combination therapy has more rare adverse effects than monotherapy. (4) Combination of low-dose Losartan and Amlodipine is a kind of treatment, m...
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