Effect of amlodipine combined with telmisartan or compound amiloride on plasma ET-1 concentration and left ventricular diastolic function of essential hypertension patients with left ventricular hypertrophy

Objective: To observe the effect of different combination antihypertensive therapies on plasma endothelin-1(ET-1) concentration and left ventricular diastolic function of essential hypertension patients with left ventricular hypertrophy(LVH). Methods: A total of 111 patients with essential hypertension were selected, including 60 cases(34 males, 26 females) aged(60.7±5.6) years with simple hypertension, and 51 cases(28 males, 23 females) aged(61.8±7.0) years with essential hypertension complicated with LVH. Essential hypertension patients with LVH were randomly divided into the group of amlodipine(2.5 mg/d) combined with telmisartan(40 mg/d, n=26) and the group of amlodipine(2.5 mg/d) combined with amiloride(half tablet/d, n=25),and the treatment lasted for 1 year. Echocardiography was performed before and after the treatment. Left ventricular mass index(LVMI), left ventricular isovolumic relaxation time(IVRT) and other indicators were detected, and plasma ET-1 concentrations were measured for comparative analysis. And 56 patients(31 males, 25 females) aged(59.3±6.7) years with normal blood pressure in the same period in our hospital were selected as the normal control group. Results: The general clinical characteristics were similar between hypertensive LVH group, simple hypertensive group and normal healthy control group. Plasma ET-1 concentrations, LVMI and IVRT of hypertensive LVH group were significantly higher than those of normal control group and simple hypertension group, and the difference was statistically significant. The patients' baseline blood pressure, ET-1, LVMI, interventricular septal thickness(IVST), left ventricular posterior wall thickness(LVPWT), left ventricular end-diastolic diameter(LVEDd) and other clinical parameters showed no significant difference(P>0.05) between the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. It was found that compared with that before treatment, blood pressure could be effectively controlled(P<0.05), and LVMI, IVST, LVPWT and IVRT(P<0.05) were all lowered, and ET-1(P<0.01) was significantly reduced after 1 year of antihypertensive therapy in both the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. The group of amlodipine combined with telmisartan was better in lowering blood pressure and reducing LVMI, IVST, LVPWT, IVRT and ET-1 than the group of amlodipine combined with amiloride(P<0.05). Conclusion: Amlodipine-based combination antihypertensive therapy could reverse LVH and improve left ventricular diastolic function partly by lowering blood pressure and ET-1, and the effect of amlodipine combined with telmisartan was superior to that of amlodipine combined with amiloride.