Effects Of Diltiazem On Left Ventricular Hypertrophy And Myocardial Ischemia In Parmary Hypertensives

Objective: To investigate the effects of diltiazem on left ventricular hypertrophy (LVH) andmyocardial ischemia in essential hypertensives.Methods:One hundred and sixty patients with grade I-II essential hypertension(EH) weredivided into four groups. Forty-four hypertensives received angiotensin converting enzymeinhibitor (ACEI) benazepril10mg a day (Benazepril treated group),forty-six hypertensivesreceived angiotensin receptor blocker (ARB) irbesartana150mg a day (Irbesartana treatedgroup), thirty-six hypertensives received diltiazem hydrochloride sustained-release tablets90mg a day (Diltiazem treated group),thirty-five hypertensives received diltiazemhydrochloride sustained-release tablets90mg combined with benazepril10mg or irbesartana150mg a day(Combination treated group). All hypentensives’ height, weight, blood pressurewere recorded, as well as blood lipid profile, liver and renal functions, and fibrinogen,allunderwent echocardiographic and Ambulatory electrocardiogram (Holter ECG) exam，LVMIswere calculated.Total ischemia burden(TIB) defined as accumulation of depression of STsegment depression plus time.Results:1.Diltiazem、benazepril、irbesartana、combination treatment induced in a significantdecrease in SBP and DBP in hypertensives. SBP in Benazepril treated group were:152.14±9.99VS126.30±9.75mmHg; Irbesartana treated group were:159.45±10.05VS129.09±8.45mmHg;Diltiazem treated group were:154.94±8.84VS132.91±9.11mmHg;Combination treated groupwere162.19±6.88VS126.88±6.00mmHg(P<0.05).DBP in Benazepril treated group were:89.18±7.57VS74.84±6.83mmHg; Irbesartana treated group were:92.23±6.69VS76.93±6.86mmHg; Diltiazem treated group were:91.69±8.71VS80.22±7.64mmHg，Combination treatedgroup were93.62±7.61VS75.35±4.84mmHg (P<0.05).Among the four groups,Combinationtreated group have greater reduction in DBP compared with Diltiazem treated group(P<0.05).2.The left ventricular mass index (LVMI) of the four groups all have decreased aftertreatment compared with pre-treatment，but Irbesartana treated group has not reached statisticaldifference (P＞0.05).LVMI before treatment were110.53±34.80VS100.03±25.3g/m~2inBenazepril treated group，Irbesartana treated group were105.50±23.86VS102.74±21.97 g/m~2，Diltiazem treated group were114.34±23.51VS94.34±20.73g/m~2，Combination treatedgroup were126.74±29.53VS111.62±30.06g/m~2. The comparison among the four groupsindicated that combination treatment have better reduction in LVMI compared with irbesartana.3.TIB before treatment were2.58±1.47VS1.67±1.57min*mv in Benazepril treatedgroup，Diltiazem treated group were2.20±1.69VS1.17±1.43min*mv，Combination treatedgroup were2.25±1.64VS1.31±1.52min*mv（P<0.05), Irbesartana treated group were1.62±1.50VS1.29±1.43min*mv（P＞0.05). Benazepril have greater redudtion in TIB compared withirbesartana (P<0.05).4. Hypertensives with TIB before treatment, TIB were3.13±0.67VS2.19±1.55min*mvin Benazepril treated group, Irbesartana treated group were3.13±0.67VS1.48±1.60min*mv,Diltiazem treated group were3.53±0.69VS1.79±1.62min*mv，Combination treated groupwere3.55±0.33VS1.98±1.65min*mv(P<0.05).Benazepril have greater redudtion in TIBcompared with irbesartana (P<0.05).Hypertensives without TIB before treatment, TIB of Benazepril、Diltiazem andCombination treated groups were0.30±0.00VS0.30±0.00min*mv，while Irbesartanatreated group were0.30±0.00VS1.12±1.26min*mv（P<0.05). Benazepril、Diltiazem andCombination treated may postpone the advance of TIB while Irbesartana may have no effecton postponing the advance of TIB.Conclusion: Diltiazem、benazepril、irbesartana and combination treated comttributed to stablethe blood pressure reduction,can have redution in LVMI,have anti-ischemia effects inhypertensives,combination treatment have better reduction in LVMI compared with irbesartana;Benazepril may have better efficacy on anti-ischemia compared with irbesartana; Diltiazem、benazepril、irbesartana and combination treated can have anti-ischemia effects in hypertensiveswith TIB before treatment; Diltiazem、benazepril and combination treated can postpone theadvance of TIB while irbesartana have no effect on postponing the advance of TIB.