小剂量安体舒通治疗顽固性高血压疗效分析

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0.028、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.

Efficacy of Low-Dose Spironolactone Therapy in Patients With Resistant Hypertension

Objective To 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.Methods We 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.Results The 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）.Conclusion Low-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.