Protective Effect Of Telmisartan And Hydrochlorothiazide Tablets On Cardiac Function In Elderly Patients With Chronic Heart Failure

Chronic heart failure(CHR)is a clinical symptom that manifests itself in the development of various heart diseases.It is also the leading cause of death in heart disease patients[1,2].Related studies have shown that[3],the main mechanism responsible for the development of chronic heart failure is myocardial remodeling,namely the renin-angiotensin-aldosterone system(RAAS)and the sympathetic nervous system(Sympathetic nervous system).,SNS)is activated and overexcited and the kinin-bradykinin system(KKS)is inhibited.Therefore,in the treatment of patients with chronic heart failure,the important part is to inhibit and delay the myocardium.Remodeling.At present,drugs that block RAAS include angiotensin converting enzyme inhibitor(ACEI)represented by enalapril and angiotensin receptor antagonist(Angiotensin receptor represented by telmisartan).Blockers,ARB)two categories.In addition,there are drugs such as aldosterone receptor antagonists and renin inhibitors.ARB can inhibit the binding of Angll and AT1 receptors formed by non-ACE method through ACE,and prevent RAS effect[4],avoiding "Ang? escape phenomenon"[5].Because ARB drugs do not inhibit the hydrolysis inactivation of bradykinin,they have fewer side effects than clinical ACEI drugs,such as irritating dry cough and angioedema[6,7].Telmisartan and Hydrochlorothiazide tablets are a combination of telmisartan 80 mg/hydrochlorothiazide 12.5 mg,which is a combination of ARB and thiazide diuretics,which directly blocks Ang II and its specificity.Body binding inhibits myocardial remodeling,and at the same time,indirectly binds Ang? to AT2 receptor,enhances the ability of vascular wall smooth muscle endothelial cells to secrete NO[8],and increases myocardial cell hypertrophy,fibrosis,necrosis,apoptosis and neurohumoral endocrine factors.Containment,also synergistically achieve anti-left ventricular hypertrophy and inhibit myocardial remodeling,so that cardiovascular and vascular protection and improvement are controlled,delaying further progress.Diuretic can also reduce the retention of body fluids,relieve the load on the heart,and relieve the symptoms of heart failure.Now,with the improvement of conditions such as quality of life,technology and medical care,the population is becoming more and more aging,and cardiovascular diseases are increasing.For chronic heart failure,the number of older people is also increasing.Statistics show that[9,10,11],the probability of rehospitalization and the probability of death of chronic heart failure increase year by year[12],the clinical mortality rate is equivalent to colorectal cancer,breast cancer and other malignant tumors,but also can be called heart Cancer in the vascular disease sector[13],which imposes a large economic burden on the patient's family and country.At present,the treatment of CHF has been obvious to all,and it has become a key medical and health problem in many countries.Clinically,elderly patients with oral ACEI often have irritating dry cough and other adverse reactions,and most of the current randomized clinical trials on CHF drugs exclude older adults[14],so,for the elderly patients with chronic heart failure,cardiac function protection treatment It is especially important.Therefore,to investigate the protective effect of telmisartan and hydrochlorothiazide tablets on cardiac function in elderly patients with chronic heart failure.ObjectiveTo study the protective effect of telmisartan hydrochlorothiazide tablets on cardiac function in senile(>65 years old)patients with chronic heart failure,and provide a reliable basis for clinical.MethodsIn our hospital,we randomly selected 84 elderly patients with chronic heart failure(>65 years old)who were admitted to the hospital from December 2017 to June 2018 as the study sample,and randomized the patients according to the order of admission.For the two groups(experimental group(n=42),control group(n=42))for 6 months,the control group was treated with oral enalapril maleate 20 mg once daily(initial dose was 10 mg once a day,one week later)Increase to 20mg),furosemide 20mg once a day,spironolactone 20mg twice daily,potassium chloride tablets Ig twice daily,digoxin 0.125mg every other day,bisoprolol fumarate 2.5mg once daily(initial dose is 1.25 Mg once a day,increased to 2.5mg after one week and maintained treatment),the experimental group used telmisartan 80mg l/hydrochlorothiazide tablets 12.5mg once a day(Megasu,Shanghai Boehringer Ingelheim Pharmaceutical Co.,Ltd.production,the initial dose is Half a day,once a week,increased to one),furosemide 20mg once a day,spironolactone 20mg twice a day,potassium chloride tablets 1g twice a day,digoxin 0.125mg every other day,bisoprolol fumarate 2.5mg day Once(initial dose is 1.25mg Once a day,increase to 2.5 mg after one week and maintain treatment).Before treatment,there was no significant difference between the experimental group and the control group(p>0.05).The patients improved the liver and kidney function,ion,blood pressure and heart rate indicators within 1-2 days of treatment,and the indicators were all within the normal range.Table 1 shows.By examining the patient's echocardiographic left ventricular ejection fraction(LVEF),type B natriuretic peptide(BNP),and improving the patient's New York Heart Association(NYHA)The grading index was used to compare the changes of cardiac function between the two groups at 3 months and 6 months after treatment.The blood pressure,liver and kidney function,ion and heart rate were monitored during the treatment,as shown in Table 2.ResultsIn the experimental group of oral telmisartan and hydrochlorothiazide tablets,the echocardi left ventricular ejection fraction(LVEF),BNP and NYHA grades were compared with the control group after 3 months and 6 months of treatment:1,LVEF results showed that the LVEF of the experimental group was better than the control group after 3 months and 6 months after treatment,all of which were Sig=0.000(P<0.01 bilateral);2,BNP results confirmed that Sig=0.002(P<0.01 bilateral)after 3 months of treatment,after 6 months of treatment,the experimental group compared with the control group,Sig=0.000(P<0.01 bilateral);3,NYHA grade was P=0.043(P<0.05 bilateral)after 3 months of treatment,P=0.009(P<0.05 bilateral)after 6 months of treatment,the data were statistically different(P<0.01 bilateral)4,from the trend of Figure 1 Figure 2 can be seen:within 6 months of treatment,heart failure symptoms,BNP and LVEF significantly improved compared with the control group,so taking telmisartan and hydrochlorothiazide tablets can improve heart function,long-term use compared with the control group The improvement is more significant.5.After 3 and 6 months of treatment,there was no significant difference in liver and kidney function,ion,blood pressure and heart rate between the control group and the experimental group(p>0.05 bilateral),as shown in Table 2.ConclusionsThe experimental group and the control group of oral telmisartan and hydrochlorothiazide tablets had no significant difference before treatment.The LVEF,BNP and NYHA grading indexes were compared after 3 months and 6 months,and the experimental group was obviously better than the control group.The symptoms of aging improved significantly,and the long-term use of telmisartan hydrochlorothiazide tablets BNP,LVEF and NYHA grades improved significantly,therefore,telmisartan hydrochlorothiazide tablets have a protective effect on the heart function of elderly patients with chronic heart failure,available for clinical anti-Heart failure is used.