The Effects Of Perindopril And Losartan On The Left Ventricular Remodeling And Plasma Level Of Brain Natriuretic Peptide In Senile Congestive Heart Failure

Congestive Heart Failure(CHF) is a complex clinical syndrome characterized by the decent of the function of cardiac contractility,neurosecretion activity and abnormality of hemody. Ventricular remodeling is the basic mechanism of the occurrence and development of CHF, and neurosecretion activity is the important factor to affect ventricular remodeling. Renin-angiotension-aldosterone(RAS) activity has important effect on Ventricular remodeling when CHF. Angiotensin-converting enzyme inhibitors(ACEI) can repress Angiotensin-converting enzyme(ACE) of heart muscles to reduce the bom of Angiotension Ⅱ (Ang Ⅱ), then prevent the development of CHF. There are two paths in the formation of AngⅡ,one is tradition path, another is bypass path. In the tradition path, angiotensinogen is resolved to AngⅠ by renin, and AngⅠ is converted to AngⅡ by ACE. In the bypass path, AngⅠis converted to AngⅡ by ACE of heart and chymase. Bypass path is the same important path of AngⅡ fomation as tradition path. The function of AngⅡ realize mainly through AT1 and AT2 receptors. AT1 receptor activity results in blood vessel contractility,myocardial hypertrophy,myocarolial fibrosis and myocardiac necrosis,languish. Contrary with AT1 receptor, AT2 receptor activity has the function of blood vessel dilation and preventing cell propagation, and so on. ACEI can repress RAS, repressing AngⅡ,and repressing the function of AT1 receptor. ARBS can prevent directly AT1 recepor, increasing the function of AT1 recepor.There is a series of neurosetion abnormality, including Brain natriuretic factor(BNP) in the body when CHF. BNP is the natural antagonism of RAAS which has stronger function of natriuresis,diuresis,blood vessel relaxation,repressing RAAS,preventing the smooth muscle cell of blood vessel and endothelial cell propagation. BNP is synthesized and secreted by cardial ventride, it is the most important term to stimulate BNP secreting when left ventricular insufficiency that cardiac ventricle load and ventricular tension's change.The purpose of this study is to observe the effect on BNP through Perindopril and Losartan uniting to cure senile CHF. Method is to choose forty patients with HF, male 22, female 18, age≥60　years old, among them, coronary 30, hypertension 6, coronary together with hypertension 4, all cases' left ventricular ejection fraction (LVEF)≤45％, BNP≥221.5pg/ml,divided into two groups, Perindopril group(A group) and Perindopril with Losartan group(B group). There is no significant difference in sex ,course,age, basic disease and heart function between two groups(P>0.05). A group was given Perindopril 2mg/d, then added to 4mg/d if no side effects after one week. B group was added Losartan besides Perindopril with the dosage of 25mg/d, then added to 50mg/d if no side effects after one week, course of three months. NYHA classification,left ventricular end diastolic(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular eject fraction(LVEF) and BNP were recorded before treatment and three months after treatment. The evaluation of treatment in our country is that :heart function improved Ⅱgrades is significance; improvedⅠgrade is efficacy; no improved is invalidation.The study demonstrated: A group, significance 4(22.9﹪) efficacy 14(68.5﹪) invalidation 2(8.6﹪). B group , significance 6(31.5﹪) efficacy 13(65.7﹪), invalidation 1(2.8﹪). There is no significant difference between two groups on significance rate,efficacy rate and invalidation rate by student test(p＞0.05). Compared with A group after treatment : the level of BNP and LVEDD,LVESD of B group decreased significantly BNP(201.48±102.37vs257.7±92.31pg/ml, p＜0.05＝, LVEDD(60±4vs64±8mm p＜0.05＝, LVESD(48±5vs52±7mm p＜0.05). And LVEF improved significantly LVEF(39±12vs45±10﹪, p＜0.05). This shows that Perindopril and Losartan uniting to cure HF can overcome escape phenomenon of AngⅡand insufficiency not obstructing bypass path with ACEI alone, so obstruct RAS completely. It...