Clinical Study On The β-blockers And ACEI/ARB Treatment Of Patients With Myocardial Infarction Accompanied By Hyperglycemia

Objective To observe the effects of Long Term Anti-Neuroendocrine Treatment, administration of "β-blockers + ACEI/ARB" for 2 years,on the level of neuroendocrine hormones in plasma,the remodeling and the function of the left heart ventricule in patients with myocardial infarction and hyperglycemia.It may provide evidence for prevention and treatment of heart failure in patients with myocardial infarction and hyperglycemia.Methods 107 patients with myocardial infarction were randomly divided into two groups.The patients in group A were treated with metoprolol and ACEI(n=65),and the patients in group B were treated with carvedilol and irbesartan(n=42).Each group was further divided into Euglycemia subgroup and Hyperglycemia subgroup.The hormone levels in plasma were measured at the beginning and after 6-month treatment.The LVEDD,LVESD,LVEDV,LVESV,LVEF were measured before or after 6-month,1-year and 2-year treatment.Results The treatment of "metoprolol + ACEI" can reduce the level of neuroendocrine hormone in plasma.In group A,the level of PRA and AngⅡin plasma decreased significantly(P＜0.05) after the treatment.LVEF in euglycemia subgroup increased obviously(P＜0.05) after 2-year treatment,whereas there is not LVEF improvement in hyperglycemia group.Carvedilol and irbesartan can reduce the level of hormone in plasma as well.In group B,the level of PRA and AngⅡin plasma in both euglycemia and hyperglycemia subgroups decreased significantly after 6-month treatment (P＜0.05);LVESD decreased statistically(P＜0.05) in group B after the treatment.These data have not statistic difference between euglycemia and hyperglycemia subgroup.Conclusion Long Term Anti-Neuroendocrine Treatment can actually reduce the the level of neuroendocrine hormones in plasma in the patients with myocardial infarction.The long term administration of "metoprolol + ACEI" can improve the left ventricular function in patients with myocardial infarction without hyperglycemia.While the long term treatment of "carvedilol + irbesartan" can improve remodeling and function of the left ventricule in both euglycemia.and hyperglycemia subgroups.