目的 研究達(dá)格列凈聯(lián)合沙庫(kù)巴曲纈沙坦治療高血壓伴心力衰竭的臨床效果。方法 選取2022年1月—2024年3月在南陽南石醫(yī)院診治的172例高血壓伴心力衰竭患者，按照隨機(jī)數(shù)字表法將所有患者分為對(duì)照組和治療組，每組各86例。對(duì)照組患者口服沙庫(kù)巴曲纈沙坦鈉片，初始劑量25～50 mg/次，2次/d，根據(jù)耐受情況逐漸加大劑量，直至≤200 mg/次。治療組在對(duì)照組治療基礎(chǔ)上口服達(dá)格列凈片，初始劑量5 mg/次，1次/d，后根據(jù)情況將劑量增至10 mg/次，1次/d。兩組均連續(xù)治療7 d。觀察兩組的臨床療效，比較兩組治療前后舒張壓（DBP）、收縮壓（SBP）、心臟重構(gòu)指標(biāo)的變化情況，同時(shí)比較兩組心血管事件和復(fù)發(fā)情況。結(jié)果 治療后，治療組總有效率為97.67%，相較于對(duì)照組的86.05%更高（P＜0.05）。相較于治療前，兩組治療7 d后DBP、SBP均顯著降低（P＜0.05）；相較于對(duì)照組，治療組治療7 d后DBP、SBP更低（P＜0.05）。相較于治療前，治療7 d后兩組左心室收縮末期內(nèi)徑（LVIDS）、左心室舒張末期內(nèi)徑（LVIDD）顯著降低，而左心室高峰充盈率（LVPFR）、左室射血分?jǐn)?shù)（LVEF）顯著升高（P＜0.05）；相較于對(duì)照組，治療7 d后治療組LVIDS、LVIDD低于對(duì)照組，而LVPFR、LVEF高于對(duì)照組（P＜0.05）。治療組全因性死亡、心力衰竭再住院例數(shù)與對(duì)照組比較，差異無統(tǒng)計(jì)學(xué)意義；治療組主要心血管不良事件（MACE）率、復(fù)發(fā)率分別為23.26%、34.88%，相較于對(duì)照組的43.02%%、58.14%更低（P＜0.05）。結(jié)論 達(dá)格列凈聯(lián)合沙庫(kù)巴曲纈沙坦治療高血壓伴心力衰竭患者可降低血壓，改善心臟重構(gòu)，提高臨床療效，降低MACE和復(fù)發(fā)風(fēng)險(xiǎn)。

Objective To investigate the therapeutic effect of dapagliflozin combined with sacubitril valsartan in treatment of hypertension with heart failure. Methods A total of 172 patients with hypertension and heart failure diagnosed and treated in Nanyang Nanshi Hospital from January 2022 to March 2024 were selected and divided into control group and treatment group according to random number table method, with 86 patients in each group. Patients in control group were po administered with Sacubitril Valsartan Sodium Tablets, the initial dose was 25 — 50 mg/time, twice daily, and the dose was gradually increased according to tolerance, ≤200 mg/time. Patients in treatment group were po administered with Dapagliflozin Tablets on basis of the control group, the initial dose was 5 mg/time, once daily, and then the dose was increased to 10 mg/time, once daily according to the situation. Both groups were treated continuously for 7 d. The clinical effects of two groups were observed, and the changes of diastolic blood pressure (DBP), systolic blood pressure (SBP), and cardiac remodeling indexes before and after treatment were compared between two groups. Cardiovascular events and recurrence were compared between two groups. Results After treatment, the total effective rate of treatment group was 97.67%, higher than that of control group (86.05%) (P < 0.05). Compared with before treatment, DBP and SBP were significantly decreased in both groups after 7 d of treatment (P < 0.05). Compared with control group, DBP and SBP in treatment group were lower after 7 d of treatment (P < 0.05). Compared with before treatment, left ventricular end-systolic diameter (LVIDS) and left ventricular end-diastolic diameter (LVIDD) were significantly decreased in two groups after 7 d of treatment, but left ventricular peak filling rate (LVPFR) and left ventricular ejection fraction (LVEF) were significantly increased (P < 0.05). After 7 d of treatment, LVIDS and LVIDD in treatment group were lower than those in control group, but LVPFR and LVEF were higher than those in control group (P < 0.05). There was no significant difference between treatment group and control group in the number of all-cause death and heart failure rehospitalization. The total MACE rate and recurrence rate in treatment group were 23.26% and 34.88%, respectively, which were lower than 43.02% and 58.14% in control group (P < 0.05). Conclusion Dapagliflozin combined with sacubitril valsartan in treatment of hypertension with heart failure can reduce blood pressure, improve cardiac remodeling and clinical efficacy, which can reduce the risk of MACE and recurrence.

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