| Objectives1,To evaluate left ventricular diastolic function in patients with essential hypertension by echocardiography;2,To observe the influence of grading of blood pressure on left ventricular diastolic function;3. To analyse the interventional effects of HYZAAR on left ventricular diastolic function in patients with essential hypertension;Methods (1)Selective,exclusive criteria and drug intervention:①Selective and exclusive criteria:One hundred thirty-two patients with essential hypertension aged from 40 to 60 years old who were untreated, newly diagnosed or did not take any antihypertensive agents within 1 week were enrolled. Patients with secondary hypertension,severe liver,renal insufficiency,chronic obstructive pulmonary disease and ARB allergy(losartan)were excluded. And thirty age-matched healthy control subjects were enrolled as group Control.②Drug intervention:The above enrolled 132 patients began to receive the treatment of HYZAAR. It was initiated from the lower dose of half pill, and gradually increase to the maintenance dose (1 pill/day, very few 2 pills/day). The observation lasted for 12 weeks.(2)Detection indices:Echocardiographic parameters were detected at the beginning of enrollment(T0),4 weeks(T4),8 weeks(T8) and 12 weeks(T12)after HYZAAR treatment. Each measurement was taken from three continuous cardiac cycles, and the mean measurement was the final result.①parameters of mitral valve flow (MVF) : VE,VA,VE /VA;②parameters of left atrial structure:left atrial diameter index (LADI),left atrial area index (LAAI),left atrial volume index (LAVI);③parameters of left atrial systolic function:left atrial ejection force (LAF),left atrial ejection fraction (LAEF);④parameters of mitral annulus by TVI: VE'/VA',VE/VE';⑤parameters of pulmonary venous flow: VD,VS/VD,VTI-D,VTI-S/VTI-D,VAR,VTI-AR.Results1. Parameters of mitral valve flow ( MVF):Compared with Control group, the parameters such as VE,VE/VA decreased gradually, VA increased gradually at T0 in each group of essential hypertension compared with Control group, and the differences were significant(P<0.05); EHC group had further decreased VE,VE/VA and increased VA than EHA group(p<0.05). At the different time of HYZAAR treatment, the parameters such as VE,VE/VA tended to increase,VA tended to decrease in each essential hypertension group. Compared with T0, the parameters such as VE,VE/VA increased obviously,VA decreased obviously in EHB group and EHC group at T8 and T12 of HYZAAR treatment, and the differences were significant(P<0.05);VE,VE/VA further increased ,VA further decreased in three groups at T12 compared with those at T4 , and the differences were significant(P<0.05).2. Parameters of left atrial structure:Compared with Control group, at T0 there was a tendency for those parameters in each group of essential hypertension to increase gradually. Both EHB group and EHC group had significantly different parameters compared with Control group(p<0.05); EHC group had much larger parameters than EHA group(p<0.05). At the different time of HYZAAR treatment, parameters of left atrial structure in each essential hypertension group tended to decrease. Compared with T0, parameters of left atrial structure in EHB group and EHC group decreased obviously at T8 and T12 of HYZAAR treatment, and the differences were significant(P<0.05);EHB group and EHC group had further decrease parameters of left atrial structure at T12 compared with those at T4 .3. Parameters of left atrial systolic function:Compared with Control group, the parameters in each group of essential hypertension increased gradually at T0 compared with Control group, and the differences were significant(P<0.05); EHC group had much larger parameters than EHA group(p<0.05). At the different time of HYZAAR treatment, parameters of left atrial systolic function in each essential hypertension group tended to decrease. Compared with T0, parameters of left atrial systolic function in EHB group and EHC group decreased obviously at T8 and T12 of HYZAAR treatment, and the differences were significant(P<0.05);EHB group and EHC group had further decrease parameters of left atrial systolic function at T12 compared with those at T4 .4. Parameters of mitral annulus by TVI:Compared with Control group, the parameters such as VE'/VA' decreased gradually,VE/VE' increased gradually at T0 in each group of essential hypertension compared with Control group, and the differences were significant(P<0.05); EHC group had further decreased VE'/VA' and increased VE/VE' than EHA group(p<0.05).At the different time of HYZAAR treatment, the parameters such as VE'/VA' tended to increase,VE/VE' tended to decrease in each essential hypertension group.Compared with T0, the parameters such as VE'/VA' increased obviously,VE/VE' decreased obviously in EHB group and EHC group at T8 and T12 of HYZAAR treatment, and the differences were significan(tP<0.05);VE'/VA' further increased,VE/VE' further decreased in three groups at T12 compared with those at T4 , and the differences were significant(P<0.05).5. Parameters of pulmonary venous flow:Compared with Control group, the parameters such as VD,VTI-D decreased gradually, VS/VD,VTI-S/VTI-D,VAR,VTI-AR increased gradually at T0 in each group of essential hypertension compared with Control group, and the differences were significant(P<0.05); EHC group had further decreased VD,VTI-D and increased VS/VD,VTI-S/VTI-D,VAR,VTI-AR than EHA group(p<0.05).At the different time of HYZAAR treatment, the parameters such as VD,VTI-D tended to increase, VS/VD,VTI-S/VTI-D,VAR,VTI-AR tended to decrease in each essential hypertension group.Compared with T0, the parameters such as VD,VTI-D increased obviously, VS/VD,VTI-S/VTI-D,VAR,VTI-AR decreased obviously in EHB group and EHC group at T8 and T12 of HYZAAR treatment, and the differences were significant(P<0.05);VD,VTI-D further increased, VS/VD,VTI-S/VTI-D,VAR,VTI-AR further decreased in three groups at T12 compared with those at T4 , and the differences were significant(P<0.05).6. Left ventricular mass index:Compared with Control group, the parameter in each group of essential hypertension increased gradually at T0 compared with Control group, and the differences were significant(P<0.05); EHC group had much larger parameters than EHA group(p<0.05). At the different time of HYZAAR treatment, the parameter in each essential hypertension group tended to decrease. Compared with T0, the parameter in EHA group decreased obviously at T8 and T12 of HYZAAR treatment, and the differences were significant(P<0.05);Compared with T0, the parameter in EHB group and EHC group decreased obviously at T12 of HYZAAR treatment, and the differences were significant(P<0.05).Conclusions1. The parameters of velocity ratio of mitral valve flow(VE/VA),left atrial systolic function(LAF,LAEF),velocity ratios of mitral annular TVI(VE'/VA',VE/VE')and pulmonary venous flow(VS/VD,VTI-S/VTI-D,VAR,VTI-AR,VD,VTI-D)can sensitively reflect left ventricular diastolic function in patients with essential hypertension. In contrast,the parameters of left atrial structure were only suitable for analyzing left ventricular diastolic function in the second or third degree of patients with essential hypertension.2. Patients with different degrees of essential hypertension had left ventricular diastolic dysfunction and increased LVMI;the higher the blood pressure,the more severely impaired left ventricular diastolic function.3. At 4 weeks of HYZAAR treatment patients with the first degree of essential hypertension experienced improvement of left ventricular diastolic function, and those with the second and third degree of essential hypertension only had improved left ventricular diastolic function at 8 weeks of HYZAAR treatment. It showed the effectiveness and necessity of early and long-term antihypertensive therapy for improving left ventricular diastolic function in patients with essential hypertension.4. Blood pressure dereased after 8 weeks of HYZAAR treatment for patients with essential hypertension and LVMI became smaller.It suggested that the improvement of left ventricular diastolic function may be gained by blood pressure lowering and decrease of LVMI.
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