Turkiye Klinikleri Journal of Cardiology

.: ORIGINAL RESEARCH
Bir Kalsiyum Antagonisti Olan Amlodipine'nin Ekokardiyografik Olarak Belirlenen Sol Ventrikül Kitlesi ile Sol Ventrikül Sistolik ve Diyastolik Fonksiyonlarına Etkisi
Bir Kalsiyum Antagonisti Olan Amlodipine'nin Ekokardiyografik Olarak Belirlenen Sol Ventrikül Kitlesi ile Sol Ventrikül Sistolik ve Diyastolik Fonksiyonlarına Etkisi
Fehmi MERCANOĞLU*, Kamil ADALET**, Ercüment YILMAZ*, Elmas ORAK**, Ayşen HELVACI*, Aytaç ÖNCÜL*, Güngör ERTEM***
*İstanbul Üniversitesi, Kardiyoloji AD**, Doç.İstanbul Üniversitesi, Kardiyoloji AD***, İstanbul Üniversitesi, Kardiyoloji AD, İSTANBUL
Turkiye Klinikleri J Cardiol. 1995;8(2):82-7
Article Language: TR
Full Text
ÖZET
Çalışmanın amacı, hafif ya da orta derecede esansiyel hipertansiyon (EH) ve sol ventrikül (SV) hipertrofisi bulunan hastalarda amlodipinin etkilerini araştırmaktır. Materyell EHlu 19 hasta (6 kadın, 13 erkek; ortalama 52±8.9 yıl) oluşturdu. Tüm hastalar çalışmayı tamamladı. Tek kör iki haftalık plasebo dönemi (PD)ni takiben 5 mg/gün oral amlodipin başlandı, 6 hafta sonra diyastolik kan basıncı (DKB) hedef düzeyin (DKB < 90 mmHg) altına inmemiş ise doz 10mg/güne çıkıldı. 4., 6., 8., 10., 14., 18., 22. ve 26. haftalarda klinik vizitler; PD sonunda, 14. ve 26. haftalarda ekokardiyografik inceleme yapıldı. PDde kan basıncı (KB)nda anlamlı düşme olmadı. PD sonunda sistolik kan basıncı (SKB) 163+20 mmHg ve DKB 102+5.4 mmHg iken, 14. haftada sırasıyla 139+19 mmHg (p<0.001) ve 86+8 mmHgye (p<0.001) düştü. KBdaki bu düşüş çalışmanın sonuna kadar sebat etti. Çalışma süresince nabız dakika sayısında anlamlı değişiklik görülmedi. 19 hastanın onunda (%53) 5 mg/gün ve beşinde (%26) 10 mg/gün amlodipine ile DKB 90 mmHgnin altına indi; buna göre başarı oranı % 79 olarak belirlendi. SV kas kitle indeksi (SVMİ) PD sonunda 147+20 gm/m2 iken, 14. haftada 129+.20gm/m2ye (p<0.001), 26. haftada 123+19 gm/m2ye (14 ve 26. haftalardaki değerler için p<0.05) azaldı. Çalışma süresince sol ventrikül diyastolik disfonksiyonunda da anlamlı düzelme görüldü; PD sonunda E/A 0.7+0.1 iken 14. haftada 0.8+0.1ye (p<0.01), 26. haftada 0.9+0.2ye yükseldi (14 ve 26. haftalardaki değerler için p<0.001). Ekokardiyografik olarak belirlenen SV ejeksiyon fraksiyonu ve kalp indeksinde istatistiki olarak anlamlı değişme olmadı. Sonuç olarak, esansiyei hipertansiyonlu hastalarda günde tek doz verilen amlodipinin etkin bir antihipertansif ilaç olduğu, SV diyastolik fonksiyonlarını düzelttiği ve SV hipertrofisini gerilettiği kanısına varılmıştır.

Anahtar Kelimeler: Esansiyei hipertansiyon, Amlodipine, Sol ventrikül hipertrofisi
ABSTRACT
The aim of this study was to assess the effects of amlodipine in patients with mild to moderate essential hypertension and left ventricular hypertrophy. Nineteen patients (6 female, 13 male; mean age 52+8.9 years) with essential hypertension were included in the study and all of them completed the study. Following the 2- week singleblind placebo phase, 5 mg of amlodipine once-daily was initiated. If blood pressure (BP) could not be reduced below the aimed level diastolic blood pressure (DBP <90 mmHg) after 6 weeks, the dose of amlodipine was increased to 10 mg once-daily. Clinical evaluation was performed at weeks 4, 6, 8, 10, 14, 18, 22 and 26 and echocardiography at the end of the placebo phase and at weeks 14 and 26. No significant reduction in blood presssure was recorded during the placebo period. While systolic and DBPs were 163+20 mmHg and 102+5.4 mmHg, respectively at the end of the placebo period, these values were reduced to 139±19 mmHg (p<0.001) and to 86±8, respectively at 14th week. This reduction in BP was maintained until the end of the study. No significant alteration was seen in the heart rate during the study period. DBP was reduced to < 90 mmHg in 10/19 patients (53%) with 5 mg once-daily and in 5/19 patients (26%) with 10 mg of amlodipine once-daily. Thus, a therapeutic success of 79% was achieved. Left ventricular mass index (L VMI) was 147±20g/m2 at the end of placebo phase, and it was decreased to 129+20 g/mz at 14th week (p<0.001), and to 123+19 g/m2 at 26th week (p<0.05 between the values at 14 and 26th weeks). Also the left ventricular diastolic dysfunction improved significantly during the study. E/A ratio that was 0.7±0.1 at the end of placebo period had risen to 0.8+0.1 at 14th week (p<0.01,, and to 0.9+0.2 at 26th week (p<0.001 between the values at 14th and 26th week). Echocardiography assesment did not show statistically significant changes in left ventricular ejection fraction and cardiac index. It is concluded that amlodipine given in a single daily dose is an effective antihypertensive agent in patients with essential hypertension, improving left ventricular diastolic function and reducing left ventricular hypertrophy.

Keywords: Essential hypertension, Amlodipine, Lett ventricular hypertrophy

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