Objective To determine the reversal effect of amlodipine combined with telmisartan (AT) or compound amiloride (ACA) on hypertensive left ventricular hypertrophy (LVH), and the effect on plasma concentrations of endothelin-1 (ET-1) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the patients. Methods Fifty hypertensive patients with LVH who were admitted in Department of Cardiology, the First Affiliated Hospital of Xi’an Jiaotong University, during December 2007 to December 2008 were prospectively subjected in this study. There were 27 males and 23 females, at age of (61.2±7.2) years, and then randomly assigned to amlodipine (2.5mg/d) plus telmisartan (40mg/d) group (AT group, n=25), and amlodipine (2.5mg/d) plus compound amiloride (half a tablet/d, containing amiloride 1.25mg and hydrochlorothiazide 12.5mg) group (ACA group, n=25). The blood pressures, left ventricular mass index, plasma concentrations of ET-1 and NT-proBNP in the 2 groups were measured before and in 1 year after treatment. Another 50 healthy individuals, including, 27 males and 23 females with age of (60.4±5.4) years who received physical examination during the same period, were also enrolled as normal controls. Results The plasma concentrations of ET-1 and NT-proBNP were significantly higher in hypertensive LVH patients than in normal controls (P<0.01). There was no significant difference in baseline indices between the AT and ACA groups before treatment. After 1 year’s antihypertensive treatment, either AT group or ACA group resulted in significant decreases in systolic blood pressure, diastolic blood pressure, left ventricular mass index (LVMI), and plasma concentrations of ET-1 and NT-proBNP (P<0.01). AT group showed more significant effects on above indices than ACA group (P<0.05). Conclusion The plasma concentrations of ET-1 and NT-proBNP are closely related to hypertensive LVH. The effect of AT is superior to the ACA in the reduction of plasma ET-1 concentration and reversal of LVH. The amlodipine-based combined antihypertensive therapy reverses LVH probably through reducing blood pressure and plasma concentrations of ET-1 and NT-proBNP.%目的：评价氨氯地平联合替米沙坦（AT）或复方阿米洛利（ACA）对高血压左心室肥厚（LVH）的逆转情况及对血浆内皮素-1（ET-1）、氨基（N）端脑钠肽前体（NT-proBNP）浓度的影响。方法入选2007年12月至2008年12月于西安交通大学第一附属医院心血管内科门诊就诊的原发性高血压LVH患者50例，男27例，女23例，年龄（61.2±7.2）岁，随机分为氨氯地平（2.5mg/d）联合替米沙坦（40mg/d）组（AT组，n＝25）和氨氯地平（2.5mg/d）联合复方阿米洛利（0.5片/d，含盐酸阿米洛利1.25mg和氢氯噻嗪12.5mg）组（ACA组，n＝25）。治疗期1年，分别于治疗前后对两组患者血压、左心室质量指数、血浆ET-1和NT-proBNP浓度等指标进行检测。选择同期在本院体检正常者50例，男27例，女23例，年龄（60.4±5.4）岁，作为正常对照组。结果高血压LVH患者血浆ET-1和NT-proBNP浓度均较正常对照组显著升高（P＜0.01）。治疗前AT组和ACA组基线临床特征相似。降压治疗1年后，AT组及ACA组患者收缩压、舒张压、左心室质量指数、血浆ET-1和NT-proBNP浓度均较治疗前明显降低（P＜0.01），其中AT组降低收缩压、舒张压、左心室质量指数及血浆ET-1浓度作用强于ACA组（P＜0.05）。结论血浆ET-1和NT-proBNP水平与高血压LVH密切相关；AT较ACA更有利于降低血浆ET-1浓度及逆转LVH；以氨氯地平为基础的联合降压治疗可能部分通过降低血压及影响血浆ET-1和NT-proBNP浓度逆转LVH。
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