目的 研究达格列净联合沙库巴曲缬沙坦治疗高血压伴心力衰竭的临床效果。方法 选取2022年1月—2024年3月在南阳南石医院诊治的172例高血压伴心力衰竭患者，按照随机数字表法将所有患者分为对照组和治疗组，每组各86例。对照组患者口服沙库巴曲缬沙坦钠片，初始剂量25～50 mg/次，2次/d，根据耐受情况逐渐加大剂量，直至≤200 mg/次。治疗组在对照组治疗基础上口服达格列净片，初始剂量5 mg/次，1次/d，后根据情况将剂量增至10 mg/次，1次/d。两组均连续治疗7 d。观察两组的临床疗效，比较两组治疗前后舒张压（DBP）、收缩压（SBP）、心脏重构指标的变化情况，同时比较两组心血管事件和复发情况。结果 治疗后，治疗组总有效率为97.67%，相较于对照组的86.05%更高（P＜0.05）。相较于治疗前，两组治疗7 d后DBP、SBP均显著降低（P＜0.05）；相较于对照组，治疗组治疗7 d后DBP、SBP更低（P＜0.05）。相较于治疗前，治疗7 d后两组左心室收缩末期内径（LVIDS）、左心室舒张末期内径（LVIDD）显著降低，而左心室高峰充盈率（LVPFR）、左室射血分数（LVEF）显著升高（P＜0.05）；相较于对照组，治疗7 d后治疗组LVIDS、LVIDD低于对照组，而LVPFR、LVEF高于对照组（P＜0.05）。治疗组全因性死亡、心力衰竭再住院例数与对照组比较，差异无统计学意义；治疗组主要心血管不良事件（MACE）率、复发率分别为23.26%、34.88%，相较于对照组的43.02%%、58.14%更低（P＜0.05）。结论 达格列净联合沙库巴曲缬沙坦治疗高血压伴心力衰竭患者可降低血压，改善心脏重构，提高临床疗效，降低MACE和复发风险。

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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