| BackgroundHypertension is one of the most common cardiovascular disease in clinical, the pathology characteristic and the clinical syndrome of systemic arterial pressure rise, long duration and target organ damage can lead to stroke, myocardial infarction, heart failure and chronic kidney disease complications such as, not only causes damage, the fatality rate is high, and on the family and society, has become a major public health problem worldwide, at the same time as the population ages, elderly patients with high blood pressure is increasing year by year. And old age hypertension has its unique clinical characteristics:(1)pulse pressure and high isolated systolic hypertension prevalence rate;(2)blood pressure fluctuations;(3)easy happening pseudo hypertension;(4)complications and complications:more easily complicated with hypertensive heart disease, heart failure, kidney failure, can increase peripheral vascular disease, stroke, arrhythmia, diabetes, hyperlipidemia, such as alzheimer’s disease progression.Heart failure (HF) is the most common complications in elderly patients with hypertension, according to the sampling statistics of our country in2003senile heart failure incidence is0.9%; According to the American heart association (AHA)2005statistical report, in the United States has about5million patients with heart failure, heart failure on the number of annual growth for550000.Hypertension is important cause of CHF, reports from Framingham show that The risk of heart failure in Hypertension patients is6times of the normal blood pressure. An increased incidence of CHF when systolic or diastolic blood pressure increases of elderly men and women,75%of patients with CHF caused by hypertension,5years after the occurrence of CHF mortality rates as high as50%. In short, hypertension is a big harm for the elderly, hypertension in elderly patients with hypertension in heart failure as well as related significantly increased the danger of death..The heart of the patients with high blood pressure by continuous blood pressure increases can increase the left ventricle load, thus cause Left ventricular wall thickening before symptoms of heart failure for the heart because of continuous blood pressure for the heart.But the heart have normal left ventricular ejection fraction and left ventricular filling reduce low, pulmonary vein pressure and left ventricular end-diastolic pressure increasing, characterized by diastolic dysfunction, the earliest known as diastolic heart failure (DHF),myocardial systolic function can be keep well, now the heart ejection fraction and LVEF is normal. Along with the further progress of the disease, cardiac ejection function decline, to appear systolic heart failure.Heart failure (HF) is a progressive disease, heart failure in neuroendocrine activation in the short term may play a compensatory role, through the activation of the sympathetic nervous system to speed up the heart rate, increase myocardial contraction force and small artery tension, increase peripheral vascular perfusion, if long-term excessive activation can cause progressie worsening in cardiac function. But if the excessive activation of neuroendocrine long-term can cause progressie worsening in cardiac function, namely the heart cavity expansion, the process of ventricular hypertrophy, myocardial cells, extracellular matrix and collagen fibres have a corresponding change, namely the ventricular remodeling process.Metoprolol and Benazepril that split is clinical commonly used antihypertensive drugs.Metoprolol therapy for heart failure in recent years of random intervention trial show that heart failure patients with selective β1receptor blockers and gradually add quantity, can prevent the deterioration of symptoms, improve patient’s symptoms, heart function and life quality, reduce the case fatality rate. β1receptor blockers influence on hemodynamics, mainly slow heart rate and lower systolic blood pressure, by reducing the heart rate, blood pressure double product, improve the myocardial oxygen consumption, is beneficial to the recovery of myocardial function when heart failure. However if a separate application of metoprolol for its inhibition of myocardial contraction force, the direct impact on cardiac function and hemodynamics, a dose will only show the deterioration of the heart failure; The long-term efficacy of consecutive months after application to show the reparative got better improvement. Benazepril is a new type of long-term angiotensin converting enzyme inhibitor, it’s application in chronic heart failure mechanism is that the main function of inhibiting renin angiotensin aldosterone system and adrenergic pathway, acting on the excitation peptidase II, inhibition of slow degradation of peptide,expanding blood vessels increased formation of prostaglandin. If a separate application of Benazepril, however, due to the ACE activity was suppressed, and by other means, still sustainable produce Ang II and weaken its curative effect.Large clinical trials show that effective control of blood pressure in elderly people can obtain the same as the young and middle-aged patients with high blood pressure and even greater benefits. However, for a long time in clinical practice, the elderly hypertension with heart failure treatment, the patient’s blood pressure control rates are lower than the general population, such people are often at the same time with a variety of chronic diseases, heart failure and the performance of the difference is very big, these are no doubt even more difficult for clinical prevention and treatment.So the research on senile hypertension prevention and cure of heart failure as an important topic in the field of cardiovascular disease, Benazepril and metoprolol in the treatment of senile hypertension and heart failure alone have certain curative effect, but each has some deficiencies, And both applications can gain more benefits, this research is less.ObjectivesThe purpose of this study was to investigate:(1)Observing the antihypertensive effects of Benazepril combined with metoprolol in the treatment of elderly hypertensive patients with heart failuret.(2)Observing the cardiac function change in the indicators of elderly hypertensive patients with heart failuret by Benazepril combined with metoprolol in the treatment. Subjects and methodsThe144cases of elderly hypertensive patients with heart failure were randomly divided into observation group and control group, control group2,48cases in each group. Control group1was given Benazepril therapy, control group2was given metoprolo therapy. Observe cardiac function indexes including patient’s blood pressure, heart rate and left ventricular end-diastolic Canon (LVEDD), left ventricular end systolic Canon (LVESD), left ventricular ejection fraction (LVEF),6minutes walk test of ease group.Results(1)After treatment,36cases in the observation group of48patients was Obviously effective,10cases were effective and2cases was ineffective, total effective rate was95.83%.19cases in control group1of48patients was Obviously effective,18cases were effective and11cases was ineffective, total effective rate was77.08%.17cases in control group2of48patients was Obviously effective,19cases were effective and12cases was ineffective, total effective rate was75.00%.The total effective rate of Observation group is significantly higher than control1group, control group2(p<0.01).(2) After treatment, the control group1、control group2and the observation group are different degrees of lower blood pressure and heart rate, the difference was statistically significant compared with before treatment (P<0.01). The reduction of blood pressure and heart rate of observation group was statistically significant compared with control group1and control group2.(3) Cardiac function indexes including left ventricular end-diastolic Canon (LVEDD), left ventricular end systolic Canon (LVESD), left ventricular ejection fraction (LVEF) after treatment of the control group1%control group2and the observation group have different degrees of improvement,the observation group improved significantly, compared with before treatment and control groups1and control group2.The difference had statistical significance (P<0.01). (4) After treatment, the6min walking test indexes of the three groups have different degrees of improvement, the observation group improved significantly, compared with before treatment and control group1and control group2in the same period, The difference had statistical significance (all P<0.01).Conclusions(1)Benazepril combined with metoprolol applied in patients with essential hypertension can obtain coordination of antihypertensive effect.(2) Benazepril combined with metoprolol applied in patients with essential hypertension can improve the patient’s heart function,which can delay or prevent the complications of hypertension and heart failure. |
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