Abstract:

Objective　To observe the effect of telmisartan combined with conventional anticoagulant therapy on improving clinical features and cardiac function in patients with acute myocardial infarction (AMI) and hypertension. Methods　This was a randomized controlled trial. A total of 123 AMI patients with hypertension admitted to Nanyang First People's Hospital from January 2021 to February 2023 were divided into two groups by the random number table method, with 62 cases in the observation group and 61 cases in the control group. In the observation group, there were 32 males and 30 females, aged (60.44±5.27) years. In the control group, there were 33 males and 28 females, aged (61.25±5.16) years. The control group only received conventional anticoagulation treatment, and the observation group received telmisartan combined with conventional anticoagulation treatment. The changes in blood pressure levels, cardiovascular endothelial function, and cardiac function indicators before and after treatment and medication safety were compared between the two groups. χ² test and t test were used. Results　After treatment, the systolic blood pressure and diastolic blood pressure in the observation group were (115.25±20.33) mmHg (1 mmHg = 0.133 kPa) and (80.25±10.61) mmHg, which were both lower than those in the control group [(130.27±20.16) mmHg and (87.62±10.24) mmHg], with statistically significant differences (both P<0.05). After treatment, the blood flow mediated vasodilation (FMD) of the observation group was (12.21±3.16)%, and the nitroglycerin mediated vasodilation (NMD) was (9.44±2.16)%, which were both higher than those of the control group [(10.45±3.28)% and (8.76±2.15)%]; the pulse wave velocity (PWV) was (10.33±3.26) m/s, which was lower than that of the control group [(12.28±3.15) m/s], with statistically significant differences (all P<0.05). After treatment, the left ventricular ejection fraction (LVEF) of the observation group was (55.25±10.27)%, which was higher than that of the control group [(49.36±10.27)%]; the left ventricular end-diastolic diameter (LVDD) was (40.33±10.27) mm, and the left ventricular posterior wall thickness (LVPW) was (9.52±3.46) mm, which were lower than those of the control group [(46.62±10.31) mm and (11.45±3.46) mm], with statistically significant differences (all P<0.05). After treatment, the incidence of drug-related adverse reactions in the observation group was 6.45% (4/62), which was slightly higher than that in the control group [4.92% (3/61)], with no statistically significant difference (P>0.05). Conclusions　Telmisartan combined with conventional anticoagulant therapy can lower the blood pressure level in patients with AMI and hypertension, and has positive significance in improving their cardiovascular endothelial function and cardiac function. The combined use of this drug does not significantly increase the risk of drug-related adverse reactions in patients, with high safety.

Key words:

Acute myocardial infarction, Hypertension, Telmisartan, Anticoagulant therapy, Cardiac function

摘要：

目的　观察替米沙坦结合常规抗凝治疗改善急性心肌梗死（AMI）伴高血压患者临床特征及心功能的效果。方法　本文为随机对照试验，病例纳入时间为2021年1月至2023年2月，研究对象为南阳市第一人民医院收治的123例AMI伴高血压患者，采用随机数字表法将入组患者分为两组，分别列为观察组（62例）和对照组（61例）。观察组中男32例，女30例，年龄（60.44±5.27）岁；对照组中男33例，女28例，年龄（61.25±5.16）岁。对照组仅接受常规抗凝治疗，观察组采用替米沙坦结合常规抗凝治疗，比较两组患者治疗前后的血压水平、心血管内皮功能、心功能指标变化情况及用药安全性。采用χ²检验、t检验。结果　治疗后，观察组的收缩压为（115.25±20.33）mmHg（1 mmHg=0.133 kPa），舒张压为（80.25±10.61）mmHg，均低于对照组［（130.27±20.16）mmHg、（87.62±10.24）mmHg］，差异均有统计学意义（均P<0.05）。治疗后，观察组的血流介导下血管扩张程度（FMD）为（12.21±3.16）%，硝酸甘油介导下血管内皮舒张程度（NMD）为（9.44±2.16）%，均高于对照组［（10.45±3.28）%、（8.76±2.15）%］，脉搏波传导速度（PWV）为（10.33±3.26）m/s，低于对照组（12.28±3.15）m/s，差异均有统计学意义（均P<0.05）。治疗后，观察组的左心室射血分数（LVEF）为（55.25±10.27）%，高于对照组（49.36±10.27）%，左心室舒张末期内径（LVDD）为（40.33±10.27）mm，左心室后壁厚度（LVPW）为（9.52±3.46）mm，均低于对照组［（46.62±10.31）mm、（11.45±3.46）mm］，差异均有统计学意义（均P<0.05）。治疗后，观察组的药物相关不良反应发生率为6.45%（4/62），略高于对照组4.92%（3/61），差异无统计学意义（P>0.05）。结论　替米沙坦联合常规抗凝治疗能下调AMI伴高血压患者的血压水平，对改善患者心血管内皮功能、心功能均有积极意义，联合应用此药未明显增加患者的药物相关不良反应发生风险，安全性较高。

关键词:

急性心肌梗死, 高血压, 替米沙坦, 抗凝治疗, 心功能