Left ventricular hypertrophy (LVH) is a major risk factor for cardiovascular morbidity in hypertensive patients. The effects of diuretics on LVH have raised controversies, but recent studies suggest that diuretics are able to reduce LVH in hypertensive patients, mainly through a reduction in ventricular diameter. The present multicenter open study was designed to test the effects of indapamide, a widely used nonthiazide diuretic, on LVH in patients with essential hypertension. Patients had to have mild-to-moderate essential hypertension (supine diastolic blood pressure [sDBP] 95 to 115 mm Hg) with echocardiographic evidence of LVH (left ventricular mass index [LVMI] > 130 g/m2 for men and > 110 g/m2 for women). After a 2 week placebo run-in period, eligible patients underwent a 6 month treatment with 2.5 mg indapamide daily. All echograms were performed by the same investigator before and after 6 months of indapamide. Clinical and biological acceptability and quality of life (visual analog scale) were also studied. One hundred and thirty patients were included in the study and 112 completed the trial. Indapamide induced a significant reduction i systolic and diastolic blood pressures. Indapamide induced a marked reduction in posterior wall thickness (from 12.1 +/- 2.0 to 11.2 +/- 1.6 mm) and in interventricular wall thickness (from 12.7 +/- 1.7 to 11.8 +/- 1.9 mm; each P < .001) and a slight decrease in left ventricular diameter (P = .049). This resulted in a 13% reduction in LVMI (from 161.9 +/- 37.9 to 140.7 +/- 33.8 g/m2, P < .001). Left ventricular fractional shortening remained unchanged. There was no significant relation between changes in LVMI and changes in systolic, diastolic, or mean blood pressure. No significant adverse clinical or biological effects were reported during the study. The increased score of the visual analog scale indicated that overall well-being was improved (P < .001). Our study indicates that indapamide, in addition to blood pressure control, is able to reduce LVH. This effect was achieved mainly through a reduction in wall thicknesses rather than in internal cavity diameter.

译文

左心室肥大(LVH)是高血压患者心血管疾病的主要危险因素。利尿剂对LVH的影响引起了争议,但最近的研究表明,利尿剂能够降低高血压患者的LVH,主要是通过减小心室直径。当前的多中心开放研究旨在测试吲哚帕胺(一种广泛使用的非噻嗪类利尿剂)对原发性高血压患者左室肥厚的影响。患者必须患有轻度至中度的原发性高血压(仰卧舒张压[sDBP] 95至115 mm Hg),并伴有LVH的超声心动图证据(男性左心室质量指数[LVMI]> 130 g / m2,> 110 g / m2)平方米(女士)。经过2周的安慰剂磨合期后,合格的患者每天接受2.5毫克吲达帕胺治疗6个月。在吲达帕胺治疗6个月之前和之后,所有超声检查均由同一位研究人员进行。还研究了临床和生物学可接受性以及生活质量(视觉模拟量表)。这项研究纳入了130位患者,其中112位完成了试验。吲达帕胺引起收缩压和舒张压的显着降低。吲达帕胺引起后壁厚度(从12.1 /-2.0降低到11.2 /-1.6 mm)和心室壁厚度(从12.7 /-1.7降低到11.8 /-1.9 mm;每个P <.001)显着降低,并略有降低在左心室直径(P = .049)。这导致LVMI降低了13%(从161.9 /-37.9降至140.7 /-33.8 g / m2,P <.001)。左心室分数缩短保持不变。 LVMI的变化与收缩压,舒张压或平均血压的变化之间没有显着关系。在研究过程中,未见明显的不良临床或生物学影响。视觉模拟量表评分的增加表明总体健康水平得到了改善(P <.001)。我们的研究表明,吲达帕胺除了可以控制血压外,还可以降低LVH。这种效果主要是通过减小壁厚而不是减小内腔直径来实现的。

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