| Objective:To investigate the effects of Renin-Angiotensin System Inhibitor combined withDiltiazem on left ventricular hypertrophy (LVH) and myocardial ischemia in essentialhypertensives.Methods:One hundred and sixty-eight patients with grades I-II essential hypertension(EH)were divided into four groups. Fifty-two hypertensives received Irbesartan150mgadding Diltiazem Capsule90mg a day (Irbesartan adding Diltiazem treated group, A),thirty-six hypertensives received Benazepril10mg adding Diltiazem90mg a day(Irbesartan adding Diltiazem treated group, B), thirty-five hypertensives receivedDiltiazem90mg a day (Diltiazem treated group, C), and forty-five hypertensivesreceived Irbesartan150mg or Benazepril10mg a day (RAS blocker treated group, D).Patients were followed up for an average of13.91months. All hypentensives’ height,weight, blood pressure were recorded, as well as blood lipid profile, liver and renalfunctions, and fibrinogen. All the patients underwent echocardiographic andAmbulatory electrocardiogram (Holter ECG) exam，left ventricular mass index(LVMI)were calculated pre and post-treatment.Total ischemia burden(TIB) was defined asaccumulation of depression of ST segment depression plus time. The index of TBIwas converted by log10because TBI was not in normal distribution. The drug efficacywas reflected by the reduction percentage after the treatment if the baseline wasuneven.Results:1.The SBP and DBP of post-treatment were significantly decreased in A、B、C、D groups when compared with that of pre-treatment(P<0.01).SBP in different teatedgroups were described respectively as follows (pre VS post treatments):A:168.83±7.98VS130.50±3.09mmHg(-22.70%), B:165.60±4.70VS127.90±4.73mm Hg (-22.77%), C:156.57±8.79VS127.00±6.26mmHg(-18.89%), D:154.12±10.69VS125.82±7.35mmHg (-18.36%). There were no difference in reducing SBP between Aand B, and also between C and D (P＞0.05).DBP (pre VS post treatments):A:96.92±9.40VS72.67±8.06mmHg， B:97.00±7.89VS74.70±4.22mmHg,C:95.43±2.53VS76.64±8.17mmHg，D:93.42±8.92VS75.10±5.57mmHg，There wasno difference in reducing DBP among these four treated groups（P＞0.05）.2.The IVST and LVMI of post-treatment were significantly decreased in A、B、C、 D groups compared with that of pre-treatment(P<0.05).IVST (pre VS posttreatments): A：1.24±0.10VS1.04±0.08g/m2(-16.29%), B:1.26±0.12VS1.02±0.11g/m2(-19.05%), C:1.23±0.09VS1.09±0.07g/m2(-11.38%), D:1.23±0.11VS1.07±0.06g/m2(-13.01%).Among these four groups, B had a greater reduction in IVSTcompared with C and D (P<0.05).LVMI (pre VS post treatments): A126.07±14.30VS105.33±12.31g/m2(-16.45%), B:128.03±18.05VS103.37±15.24g/m2(-19.26%),C:125.99±18.27VS112.80±16.16g/m2(-10.47%), D:126.45±19.31VS108.11±15.12g/m2(-14.50%). Compared to C, B had a greater reduction in LVMI(P<0.05).3.The TIB（24hour) of post-treatment were significantly decreased in A、B、Cgroups when compared with that of pre-treatment(P<0.05). A:2.01±0.86VS1.32±0.54(-34.33%), B:2.64±1.03VS1.56±0.65(-40.91%), C:1.97±0.76VS1.22±0.57(-38.07%), D:1.12±0.47VS1.07±0.45(-4.46%), There was no significant differencebetween pre and post treatments in D as to TIB（P＞0.05）, B had less reduction inTIB compared with C（P＞0.05）.Conclusion:(1) RAS inhibitor、Diltiazem and RAS inhibitor combined with Diltiazem can reduceblood pressure and reverse ventricular hypertrophy;(2) There are no difference inreducing SBP between RAS inhibitor and Diltiazem, and also between Irbesartancombined with Diltiazem and Benazepril combined with Diltiazem;(3)There is nosignificant difference in reducing DBP among these four groups;(4) Benazeprilcombined with Diltiazem has better efficacy on reversing ventricular hypertrophy compared with Diltiazem or RAS inhibitor；(5)Diltiazem and RAS inhibitor combinedwith Diltiazem have anti-ischemia effect on hypertensives, while Irbesartan may haveno effect on anti-ischemia. |
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