| Background Hypertension is the most common cardiovascular diseases.and it is harmful to the health of our people. Left ventricular hypertrophy(LVH)are the most characteristic one of the changes. Currently recognized, LVH caused by high blood pressure occurred in a variety of cardiovascular complications are independent risk factors. LVH and cardiac systolic and diastolic function of the decline in coronary flow reserve reduction and a variety of arrhythmias is closely related to happen. Therefore, people wishing to fundamentally improve the prognosis of patients with hypertension, in addition to lower blood pressure to the desired level, but also necessary to reverse LVH, reversal of LVH in hypertensive patients is to improve the prognosis of the key, have important clinical value. Therefore, in the choice of antihypertensive agents on, have to select those who can effectively buck LVH can prevent and reverse the antihypertensive drugs. In recent years, domestic and external aspects of reversal of LVH many job, consider various types of antihypertensive drugs LVH reversal mechanisms and effects are different. At home and abroad a number of clinical studies have shown that calcium antagonists,angiotensin-convertingenzyme inhibitor, angiontens in receptor blockers,diuretics,endothelin receptor blockers in patients with hypertension have reversed the role of left ventricular hypertrophy. Although left ventricular hypertrophy research has made tremendous progress, but a variety of antihypertensive drugs to reverse the effects of LVH have a greater difference in the report, single-drug combination therapy is better than poor. What people antihypertensive combination therapy programs to better the reversal of left ventricular hypertrophy, there is no definite answer. Leptin are obese gene (ob) encoding a product, mainly by the fat cells secrete a hormone cycle. The current study also showed that the majority of hypertensive patients with elevated leptin levels. However, LVH in hypertensive patients with leptin concentrations and drug concentrations after the intervention of change is not very clear, therefore, the possibility of leptin as an early prediction of left ventricular hypertrophy in patients with high sensitivity and high specificity of indicators, there is no relevant reports.Objective This study was designed to compare the application of united amlodipine plus telmisartan optimize antihypertensive therapy than amlodipine plus amiloride standard antihypertensive therapy in the prevention and treatment of hypertension and reversal of left ventricular hypertrophy connection optimize better antihypertensive treatment standard antihypertensive therapy and left ventricular hypertrophy observed in patients with serum leptin level changes, thereby screening out the early prediction of left ventricular hypertrophy the high sensitivity and high specificity of indicators.Methods (1),Medical choices according to 2005 guidelines for hypertension prevention and treatment proposed diagnostic criteria for hypertension, diagnosed in patients with essential hypertension, at the same time by echocardiography diagnosed with LVH, after elution by inclusion criteria to achieve blood pressure [systolic pressure≥140mmHg and / (or) diastolic blood pressure≥90mmHg]. 49 cases of male, female 43 cases, a total of 92 cases. Patients aged 50 ~ 79 years old, an average of 64±5 years old. To exclude secondary hypertension, unstable angina, acute cardiovascular and cerebrovascular events (3 months), serious kidney and liver diseases, cancer, gout, pregnancy, as well as the study of drug allergy and contraindication of clear patients. (2),Experimental grouping 92 patients were randomly assigned to Amlodipine + compound hydrochloride amiloride group 46 (male 25, female 21),average (65±4) and Amlodipine + telmisartan group 46 (male 24, female 22) cases,average (66±3). Random number generated by the Beijing Center for random. Two groups of patients with the drug are as follows: amlodipine 2.5 mg/d + compound amiloride 1 table/d; amlodipine 2.5 mg/d + telmisartan 80 mg/d.(3),Color Doppler echocardiography measured①,morphological characteristics of left ventricular hypertrophy: diastolic interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular internal diameter (LVID). Observation of the imaging features of left ventricular hypertrophy. Under the formula: left ventricular mass (LVM) = 1.04 [(LVID + IVST + LVPWT)-LVID] 3 -13.6, left ventricular mass index (LVMI) = LVM / BSA (g/㎡).Diagnostic criteria for left ventricular hypertrophy:LVMI: Male:≥131g/㎡ ,Female:≥108g/㎡ .②,Heart function test:take the left ventricular long-axis cross-section, M-mode ultrasonography measuring the level of mitral valve chordae tendineae of left ventricular systolic function indicators:left ventricular ejection fraction (LVEF);left ventricular diastolic function:The apical four chamber view,pulsed Doppler sample volume apex mitral home to the largest spectrum of mitral prevail before taking five cardiac cycle indicator measuring the average of the following: mitral valve early diastolic peak flow velocity (E peak), mitral peak late diastolic velocity (A peak), E/A ratio. (4),Determination of biomarkers: leptin, reflecting the degree of left ventricular hypertrophy .(5),For each follow-up observation of patients for one year, one month follow-up times. Observation of cardiac and vascular structure and function changes.Results (1) Amlodipine + telmisartan group systolic blood pressure fell from157±4mmHg to123±6mmHg, diastolic blood pressure dropped from 98±5mmHg to 76±6mmHg;Amlodipine + compound hydrochloride amiloride group systolic blood pressure fell from156±5mmHg to127±5mmHg,diastolic blood pressure dropped from 97±7mmHg to 82±5mmHg; each group before and after treatment comparison of blood pressure have very significant difference (P<0.01). But between the two groups after treatment difference in SBP and DBP was not significant (P>0.05).(2) Amlodipine + telmisartan group septal thickness fell from 12.7±1.5mm to 9.8±0.6mm,left ventricular mass decreased from 311.3±15.4g to 245.2±19.7g,left ventricular mass index fell from179.8±9.2g/m~2to138.6±10.5g/m~2.Amlodipine + compound hydrochloride Amiloride group septum thickness down from 12.3±1.6mm to 10.5±0.4mm, left ventricular mass dropped from 338.6±24.3g to270.7±18.6g,left ventricular mass index dropped from 187.2±12.1g/m~2 to161.4±9.7g/m~2.Each group before and after treatment of ventricular septal thickness, left ventricular mass, left ventricular mass index of comparison there was a significant difference (all P <0. 01); Amlodipine + telmisartan group and Amlodipine + compound hydrochloride Amiloli group significantly different (P<0. 05).(3) Amlodipine + telmisartan group E/A ratio developed from 0.6±0.4 to 1.0±0.2, EF values developed from 65.7±3.6% to 68.1±4.4%;Amlodipine + compound hydrochloride amiloride group E/A ratio developed from 0.6±0.3 to 0.8±0.2, EF values developed from 62.4±4.1% to 63.4±3.9%.Each group before and after treatment E/A ratio, EF values comparisons were significant differences (P <0. 05);Amlodipine + telmisartan group than the Amlodipine+compound amiloride hydrochloride group more obvious differences (P <0. 05). (4) Serum leptin levels of amlodipine + telmisartan group decreased from (7.2±1.9)μg/L to (3.4±1.3)μg/L, amlodipine + compound hydrochloride amiloride group decreased from (7.3±1.6)μg/L to (4.8±1.3)μg/L.Each group of serum leptin levels before and after treatment comparison there was a significant difference (P <0. 01); Amlodipine + telmisartan group than Amlodipine + compound hydrochloride amiloride group more significant differences (P <0.05). (5) Serum adiponectin levels of Amlodipine + telmisartan group developed from (6.3±1.2)μg/mL to (8.1±1.8)μg/mL,Amlodipine + compound hydrochloride amiloride group developed from (6.1±1.3)μg /mL to (7.2±1.6)μg/mL.Each group of serum adiponectin levels before and after treatment comparison there was a significant difference (P <0.01,P <0.05);Amlodipine + telmisartan group than Amlodipine + compound amiloride hydrochloride group more significant differences (P<0. 05). (6) In the effects of Amlodipine+telmisartan or amiloride, high blood pressure in patients with LVH as the reduction of left ventricular mass index, serum leptin levels decreased, the total Inter was a significant positive correlation (r = 0.742, P <0.01). (7) In the effects of Amlodipine+telmisartan or amiloride, high blood pressure in patients with LVH as the reduction of left ventricular mass index, serum levels of adiponectin increase in the ensuing two between was negatively correlated (r =- 0.367, P <0.01). (8) In the effects of Amlodipine+telmisartan or amiloride, high blood pressure in patients with LVH with a lower level of serum leptin, serum levels of adiponectin increase in the ensuing two between was negatively correlated (r =- 0.312, P <0.01)Conclusion Amlodipine + telmisartan group and Amlodipine + compound amiloride hydrochloride group were significantly lower blood pressure, reverse left ventricular hypertrophy in hypertensive patients, developed EF values and improving cardiac function and left ventricular hypertrophy in patients with lower serum leptin levels .However,Amlodipine + telmisartan group than the Amlodipine + compound hydrochloride amiloride group can have more pronounced reversal of left ventricular hypertrophy and developed EF values and improve cardiac function and reduce the role of serum leptin level. Prompted Amlodipine + telmisartan group has a better effect of the treatment of hypertension, the role of the protection of the heart. And prompts leptin and adiponectin involved in the occurrence of left ventricular hypertrophy, development.
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