| Objectives:(1) To evaluate the influence and safety of Irbesartan, Benidipine and combined with them on blood pressure and left ventricular remodeling in hypertensive patients with left ventricular hypertrophy (LVH). (2) To find an ideal treatment protocols to improve efficacy, reduce adverse reaction, and protect target organs, and then reduce cardiovascular morbidity and mortality by comparing monotherapy with combination therapy.Methods:135 hypertensive patients with LVH were selected from January 2007 to June 2009 at the department of cardiology of the Second Hospital of the Shandong University. The study population was randomly divided into three groups (45 patients in each):Irbesartan group (150mg/d), Benidipine group (8mg/d), and Irbesartan plus Benidipine group (Irbesartan 75mg/d+Benidipine 4mg/d). All patients were treated for 24 weeks. Blood pressure and heart rate were measured each week, and biochemical parameters such as liver fuction, renal fuction, fasting glucose, blood lipids, and blood potassium were measured and evaluated before and after the treatment each patient. Left ventricular diameter in diastole (LVD), interventricular septum diameter (IVSTD), post wall thickness of left ventricle (PWT) and index of left ventricular mass (LVMI) were assessed as measurements of LVH. Adverse reactions of the drugs were also compared among the three groups.Results:(1) After treatment of 24 weeks, blood pressure were decreased significantly in all three groups (P<0.05). There was no difference in decrease of blood pressure between Irbesartan group and Benidipine group (P>0.05). Blood pressure was decreased more significantly in the combination group than the two monotherapy groups (P<0.05). (2) The total effectlive rate of Irbesartan group, Benidipine group and the combination group were 77.78%,77.78%,86.67%, respecetively. No statistical significant difference was found between Irbesartan group and Benidipine group (P>0.05), but the total effectlive rate of the combination group was significantly higher than the two monotherapy group (P<0.05). (3) LVD were reduced in all three groups after treatment of 24 weeks (P<0.05), IVSTD, PWT and LVMI were reduced in Benidipine group (P<0.05) and significantly reduced in Irbesartan group (P<0.01) and combination group (P<0.01) after treatment of 24 weeks. The reduced level of IVSTD, PWT and LVMI in Irbesartan group was higher than the Benidipine group (P<0.05), and that of the combination group was higher than the Irbesartan group (P<0.05) and significantly higher than the Benidipine group (P<0.01). (4) The adverse reaction rate of the combination group (4.44%) was significantly less than that of Irbesartan group (8.89%) and Benidipine group (13.33%). No statistical difference of biochemical parameter and heart rate were observed in the three groups after 24-week treatment (P>0.05).Conclusion:(1) Both Irbesartan(150mg/d) and Benidipine (8mg/d) can significantly decrease the blood pressure, alleviate and reverse LVH in the hypertensive patients with LVH. They have similar therapeutic effects in decreasing blood pressure, but Irbesartan has more advantages in alleviating and reversing LVH. (2) The combination of Irbesartan and Benidipine have a coordinate effects on steadily decreasing blood pressure and reversing LVH through different mechanisms. Moreover, the combination therapy with Irbesartan (75mg/d) and Benidipine (4mg/d) has more advantages of therapeutic effects than the two monotherapy. (3) Irbesartan (75mg/d) and Benidipine (4mg/d) doesn't affect metabolic factors and has less adverse reactions. (4) The combination of low-dose Irbesartan and Benidipine is a more reasonable, safe, and effective treatment protocols for the hypertensive patients with LVH.
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