RAS阻断剂治疗原发性高血压醛固酮逃逸现象临床观察  

Aldosterone escape in treatment of essential hypertension with RAS blockers

作　　者：张后民[1] 熊刚[1] 

机构地区：[1]重庆三峡医药高等专科学校第二附属医院心内科,404000

出　　处：《重庆医学》2009年第21期2703-2704,2706,共3页Chongqing medicine

摘　　要：目的观察血管紧张素转换酶抑制剂(ACEI)及血管紧张素Ⅱ受体拮抗剂(ARB)在原发性高血压长期治疗过程中是否存在醛固酮逃逸。方法将63例原发性高血压患者随机分为培哚普利组(32例)和氯沙坦组(31例),测定治疗前、治疗后1、3、6个月时的血压变化和血浆AngⅡ、Ald的活性,判断有无并发醛固酮逃逸。结果(1)治疗后两组血压均明显下降,比较两组的血压下降,差异无统计学意义(P>0.05)。(2)培哚普利组治疗1、3、6个月后血AngⅡ较治疗前明显下降差异有统计学意义,治疗3、6个月后与1个月比较AngⅡ轻度升高,但差异无统计学意义(P>0.05);而Ald治疗1个月后较治疗前差异有统计学意义(P<0.01),治疗3、6个月后则升高,接近治疗前水平,与治疗前比较差异无统计学意义(P>0.05)。氯沙坦组血AngⅡ治疗后1个月与治疗前比较上升,但差异无统计学意义,治疗3、6个月时较治疗前上升,差异有统计学意义;血Ald治疗后1、3、6个月浓度明显下降,与治疗前比较差异有统计学意义(P<0.01)。结论原发性高血压患者长期(3个月以上)使用ACEI培哚普利部分患者存在醛固酮逃逸现象;氯沙坦不存在醛固酮逃逸现象,治疗后两组血压均明显下降。Objective To investigate aldosterone escape in the treatment of essential hypertension with different RAS blockers. Methods The 63 essential hypertension patients were randomly divided into perindopril group（32 patients） and losartan group（31 patients）. The blood pressure, Ang Ⅱ ,Ald levels were examined at the following time points：before therapy and one month, third month,sixth months after the therapy. Results The levels of blood pressure decreased in both groups,and there was no significant difference in two groups（P〉0.05）. In perindopril group, the Ang Ⅱ levels all decreased significantly （P〈0.05） at the following times：one-month, three-month and six-month after therapy. The Ang Ⅱ levels of three-month and six-month after therapy decreased more than that of one-month after therapy,without statistical significance. The Aid level decreased significantly at the time of onemonth after therapy （P〈0.01）;but increased near to before therapy （P〉0.05） at the time of three-month and six-month after therapy,without statistical significance. In losartan group,the level of Ang Ⅱ increased at the time of one-month after therapy（P〉 0.05） ; the levels of Ang Ⅱ increased both at the time of three-month and six-month after therapy（P〈0.05） ;the levels of Ald all decreased significantly （P〈0. 01） at the time of one-month,three-month and sixth-month after therapy. Conclusion Aldosterone escape could occur when the treatment lasted more than tree months in some of hypertension patients in perindopril group,hut not in losartan group. The levels of blood pressure decreased in both groups.

关 键 词：培哚普利 氯沙坦 醛固酮逃逸 

分 类 号：R544.1[医药卫生—心血管疾病] R972.4[医药卫生—内科学]