| Objective: To investigate the effects of diltiazem on myocardial ischemia in essential hypertensives.Methods: Fifty patients with glade I-Ⅱessential hypertension were divided into two groups. Twenty-seven hypertensives received benazepril 10mg or irbesartana 150 mg a day (masc-control group,n=27); twenty-three hypertensives received diltiazem hydrochloride sustained-release tablets 90mg a day (test group,n=23). All hypentensives undewent the Ambulatory electrocardiogram(Holter ECG)recording, total ischemia overload,defined as accumulation of depression of ST segment depression plus time ,stndDev and r-MSSD reflect the heart rate variability.Patients were followed for an average of 14.80 months and all parameters were determined at baseline. Nonparametric statistial Test was used because TBI was nonnormal distribution . The numerus among TBI were converted by log10 because they exist the multiple relationship.Pairs T-test was used in comparison of changes of parameters between pre and post-treatment(Two-related-samples wilcoxon was used in nonnormal distribution data). Variance analysis was used to determine the difference between groups.Results: 1.ACEI/ARB and diltiazem treatment induced in a significant decrease in SBP and DBP in hypertensives. SBP in AECI(or ARB) treated group was: 148.7±5.98mmHg VS 131.67±6.23mmHg; SBP in diltiazem treated group was: 147.26±7.51mmHg VS 129.17±8.11mmHg,(P<0.05)。DBP in AECI(or ARB) treated group was: 84.41±8.36mmHg VS 78.11±7.48mmHg,DBP in diltiazem treated group was: 85.78±9.38mmHg VS 79.00±8.28mmHg,(P<0.05)。 2.The total ischemia burden before treatment were 1694.76(2781.89)min*mv and 1308.58(2994.35)min*mv in AECI(or ARB) treated and diltiazem treated respectively ,and turned out to be1531.20(2022.24)min*mv and 140.82(2241.84)min*mv respectively,in the end of the observation after a periods of 14.8 months treatment. The total ischemia burden of post-tretment was significantly decreased in both groups when compared with that of pre-treatment(P<0.05). When the numerus among TBI were converted by log10 ,TBI was significantly decreased after ACEI (or ARB)treatment: 3.09±0.76 VS 2.69±1.07(P<0.05);but there was no difference between TBI of pre-treatment and post-tretment in diltiazem treatment group: 2.37±1.51 VS 1.88±1.43(P>0.05).There was no difference in the heart rate variability between two groups.The stndDev before treatment were 108.40(53.32)ms and 129.4(55.31)in AECI(or ARB) treated group and diltiazem treated group respectively ,and turned out to be7.19(15.81)ms and 125(51.02)ms respectively,after treatment.And the r-MSSD before treatment were 42.82(45.52)ms and 24.47(12.34)in AECI(or ARB) treated group and diltiazem treated group respectively ,and turned out to be 34.00(29.84)ms and 24.4(15.67) respectively,after treatment.Conclusion: Diltiazem attributed to stable the blood pressure reduction,and may have anti-ischemia effects in hypertensives. |
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