小剂量安体舒通治疗顽固性高血压疗效分析怎么

【摘要】目的评价在血管紧张素转化酶抑制剂、钙离子拮抗剂和利尿剂方案上联合小剂量安体舒通治疗顽固性高血压的疗效。方法将本院112例符合顽固性高血压诊断标准的患者随机分为对照组(n=56)和试验组(n=56)，两组均服用硝苯地平控释片、贝那普利和双氢克尿噻片，对照组加服卡维地洛12550 mg/d，试验组加服安体舒通2040 mg/d，两组疗程均为8周。结果随机、双盲治疗8周末， 试验组SeSBP下降值为(146±242)mm Hg、SeDBP下降值为(96±153)mm Hg、血压控制率为803%；对照组SeSBP下降值为(104±218)mm Hg、 SeDBP下降值为(72±179)mm Hg、血压控制率为536%，P值分别为0

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028、0079和0003。与对照组相比，试验组治疗后血K+、血肌酐明显升高(041±005比011±007，796±226比089±002；P值分别为0001和0003)，血Na+变化两组无统计学差异(P=0169)。结论联合小剂量安体舒通治疗顽固性高血压可以有效降低患者的收缩压，提高血压控制率，但同时应注意密切监测患者血钾及血肌酐水平。
【关键词】安体舒通；顽固性高血压；疗效
Efficacy of LowDose Spironolactone Therapy in Patients With Resistant HypertensionMA Bin.Department of cardiology,the Poeple’s Hosptial of Gaoan city Jiangxi province,Gaoan 300800,China
【Abstract】ObjectiveTo evaluate the efficacy of adding lowdose spironolactone to multidrug regiments that included a angiotensinconverting enzyme, a calcium channel blocker and diuretic in patients with resistant hypertension MethodsWe enrolled 112 patients randomly divided into two groups: the control group: patients received Carvedilol 125～50 mg/d and the experimental group: patients received spironolactone 20～40 mg/d The duration of treatment in the two groups was 8 weeks ResultsThe randomized，doubleblind treatment for 8 weeks，the mean value of SeSBP reduction，SeDBP reduction and the control rate of blood pressure were(146±242)mm Hg，(96±153)mm Hg and 803% in the experimental group respectively，and were (104±218)mm Hg，(72±179)mm Hg and 536% in the control group respectively(P=0028,0079 and 0003, respectively) Serum potassium and creatinine levels were significantly increased in the experimental group compared with the control group (041±005 vs 011±007，P=0001；796±226 vs 089±002，P= 0003，respectively)The change of serum Sodium was not significantly different between groups (P=0169)ConclusionLowdose spironolactone is effective in decreasing blood pressure when added to previous treatment of patients with resistant hypertensionIt can improve the control rate of blood pressure, but at the same time we should closely monitor patients serum potassium and creatinine levels.
【Key words】Spironolactone； Resistant Hypertension；Efficacy
作者单位：300800江西省高安市人民医院心内科顽固性高血压(Resistant Hypertension)亦称为难治性高血压，是指在改善生活方式的基础上，应用了足量且合理联合的3种降压药物(包括利尿剂)后，血压仍在目标水平之上，或至少需要4种药物才能使血压达标时，约占高血压患者的15％～20％。其对患者健康危害极大，必须采取积极、有效、安全、长期的治疗措施，而目前关于应使用何种药物改善顽固性高血压患者血压的资料有限，本研究旨在评价在三联降压药的基础上联合小剂量安体舒通治疗顽固性高血压的疗效。
1资料与方法

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目前已有研究表明，对于血压控制不佳的患者，不论伴或不伴原发性醛固酮增多症，加用小剂量安体舒通(125～50 mg/d)可获得意想不到的降压效果和保护靶器官的作用。Nishizaka等［4］发现, 76例血压控制不佳的患者加用安体舒通后,收缩压和舒张压均出现了下降,且这种降压作用不依赖血浆醛固酮基础水平或24 h尿醛固酮、血浆肾素活性或血浆醛固酮/肾素比率。ASCOTBPLA盎格鲁斯堪的维亚心脏病终点事件试验降压分支实验［5］发现,多药联合治疗时当加入第四种药物安体舒通时具有明显的降压效应, 1411例患者中收缩压和舒张压分别降低了219 mm Hg和95 mm Hg。
我国2010年高血压指南［6］推荐，顽固性高血压的治疗应在改善生活方式的基础上消除其他影响因素、诊治继发性因素以及联合应用多种降压药等。临床上目前主张顽固性高血压患者至少联合应用血管紧张素转化酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)、钙通道阻滞剂和噻嗪类利尿剂三类降压药，效果仍不理想者可再加用一种降压药如螺内酯、β受体阻滞剂、a受体阻滞剂或交感神经抑制剂(可乐定)。
本研究发现与联合卡维地洛相比，联合安体舒通治疗顽固性高血压可以更好的降低患者的血压，提高血压控制率，不良反应少且易耐受，但同时应注意密切监测患者血钾及血肌酐水平。
参考文献
［1］Calhoun D A, Jones D, Textor S, et al Resistant Hypertension: Diagnosis, Evaluation, and Treatment Hypertension,2008,51(6):14031419.
［2］Goodfriend T L, Calhoun D A Resistant Hypertension, Obesity, Sleep Apnea, and Aldosterone Hypertension,2004,43(3):518524.
［3］Jansen P M, Danser A H, Imholz B P, et al Aldosteronereceptor antagoni in hypertension Journal of Hypertension,2009,27(4).
［4］Nishizaka M K, Zaman M A, Calhoun D A Efficacy of lowdose spironolactone in subjects with resistant hypertension［ast］ Am J Hypertens,2003,16(11):925930.
［5］Chapman N, Dobson J, Wilson S, et al Effect of Spironolactone on Blood Pressure in Subjects With Resistant Hypertension Hypertension,2007,49(4):839845.
［6］中国高血

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压防治指南修订委员会中国高血压防治指南2010中华心血管病杂志,2011,39(7):579616DOI:103760/cmajissn02533758201107002.