氯沙坦与胺碘酮联合应用对减少原发性高血压合并心房颤动复发的临床观察

目的探讨血管紧张素Ⅱ受体拈抗剂氯沙坦与抗心律失常药物胺碘酮联合应用是否可以减少原发性高血压合并心房颤动的复发。方法将原发性高血压合并持续性或阵发性房颤经电转复或药物恢复窦性心律的178例患者随机分为氯沙坦组与氨氯地平组，每组89例。两组恢复窦律后均选用胺碘酮维持窦律，氯沙坦组以氯沙坦100～150mg／d作为基础用药，氨氯地平组以氨氯地平5～10mg／d作为基础用药，疗程为1a。观察两组患者1a内的房颤复发率并比较治疗前后左心房内径（LAD）、左房舒张末期容量（LAEDV）、左房收缩末期容量（LAESV）及左心房射血分数（LAEF）。结果氯沙坦组房颤复发率比氨氯地平组明显降低（16．9％哪32．6％，P〈0．05）。治疗后氯沙坦组LAD、LAEDV及LAESV较治疗前有明显下降（P〈0．01）；氨氯地平组则无明显改善。两组治疗后的LAEF均明显增加，且以氯沙坦组增加更为显著（P〈0．01）。结论氯沙坦能够逆转原发性高血压引起的左室肥厚，可以延缓左心房扩大，进而改善心房的电重塑与结构重塑，从而减少原发性高血压合并房颤的复发。

Prevention of losartan and amiodarone in relapse of atrial fibrillation in essential hypertension

Objective To observe whether the combined use of losartan and amiodarone could reduce the recurrence of atrial fibrillation （AF） in essential hypertension （EH）. Methods A total of 178 patients with EH and persistent or paroxysmal AF undergoing sinus rhythm （SR） control by electrical conversion or drugs were randomly divided into losartan group （ 100- 150 mg/d, n = 89） and amlodipine group （5-10 mg/d, n = 89）. Amiodarone were administered to maintain SR in both groups. AF recurrence, left atrial dimension （LAD）, left atrial end-diastolic volume （LAEDV）, left atrial end-systolic volume （LAESV） and left atrial ejection fraction （LAEF） were compared between two groups after 1 year. Results AF recurrence, LAD, LAEDV and LAESV improved obviously in losartan group （P 〈 0.01 or 0.05） compared with amlodipine group. LAEF increased remarkably in both groups, especially in losartan group （P〈0.01）. Conclusion Losartan may reduce the recurrence of AF in patients with EH by reversing the left ventricular hypertrophy, delaying the left atrial enlargement, and improving atrial electric and structural remodeling.