氯沙坦治疗高血压病伴高尿酸血症60例临床观察

目的探讨氯沙坦对高血压病伴高尿酸血症患者的降尿酸作用。方法 120例高血压伴高尿酸血症患者按随机数分配法分成两组,氯沙坦组60例,每天口服氯沙坦50 mg,依那普利组60例,每天口服依那普利20 mg,根据血压水平调整药物剂量,治疗8周,测定治疗前、后的收缩压、舒张压和血清尿酸水平,并进行比较。结果两组治疗后收缩压、舒张压均比治疗前明显下降（P〈0.05）,但两组差异无统计学意义（P〉0.05）;氯沙坦组血清尿酸水平治疗后比治疗前明显下降（P〈0.05）,而依那普利组则无明显变化（P〉0.05）,两组比较差异有统计学意义（P〈0.05）。结论氯沙坦可降低高血压合并高尿酸血症患者血压和血清尿酸水平,适合治疗合并高尿酸血症的高血压病人。     

厄贝沙坦与氯沙坦治疗轻、中度高血压病的比较

目的 比较厄贝沙坦与氯沙坦对轻中度高血压病患者的降压疗效。方法 采用随机、双盲研究方法。经2周的单盲、安慰剂导入期,72例坐位舒张压在95－115mmHg之间的高血压患者被随机分入厄贝沙坦75mg/天组（n=36)或氯沙坦50mg/天组（n=36)。4周末,如坐位舒张仍≥90mmHg,每日剂量加倍（厄贝沙坦150mg/天或氯沙坦100mg／天）,总疗程8周。结果 两组患者服药后血压均显著降低（P＜0．01）。经8周治疗,厄贝沙坦组平均坐位收缩压与舒张压分别降低15．0％与13．3％,在氯沙坦组分别为13．7％与14．0％。两药的有效率无显著性差别（厄贝沙坦75．0％,氯沙坦71．4％,P＞0．05）。与厄贝沙坦不同,氯沙坦组血尿酸水平显著降低。结论 在轻中度高血压的治疗中,厄贝沙坦与氯沙坦一样有效与安全。     

伊贝沙坦治疗轻中度高血压疗效和安全性的临床研究

目的　为评价新一代血管紧张素ⅡAT1受体拮抗剂伊贝沙坦 (安博维 )降压疗效及安全性 ,并与氯沙坦相比较。方法　采用随机分组平行对照方法 ,将 12 0例轻、中度高血压患者分成伊贝沙坦组(6 0例 ) ,口服 15 0mg·d- 1和氯沙坦组 (6 0例 ) ,口服 5 0mg·d- 1。观察 8周。每 2周一次上午延迟 1～ 4小时用药并测诊室谷值坐位血压、心率 ,并观察不良反应。用药前及治疗第 4周和第 8周检测血液生化。第 4周谷值坐位血压仍大于 90mmHg者加用双氢克尿噻 12 5mg·d- 1。结果　第 4周伊贝沙坦与氯沙坦正常化率分别为 4 0 %和 35 % ,第 8周伊贝沙坦与氯沙坦组血压有效反应率分别为 78 3%和6 6 7% ,(P >0 0 5 )。两组治疗前、后平均谷值坐位舒张压有显著性差异P <0 0 1。伊贝沙坦组不良反应发生率 6 6 % ,氯沙坦组为 8 3% (P >0 0 5 )。两组部分病例加用小剂量双氢克尿噻后 ,谷值坐位舒张压进一步下降。谷值坐位舒张压下降幅度 ,伊贝沙坦组优于氯沙坦组 ,P <0 0 5。结论　伊贝沙坦与氯沙坦不良反应发生率均较低 ,伊贝沙坦降低谷值坐位舒张压更有效。建议生产伊贝沙坦与小剂量双氢克尿噻的复方制剂     

厄贝沙坦与氯沙坦治疗轻、中度高血压病的比较

目的比较厄贝沙坦与氯沙坦对轻中度高血压病患者的降压疗效.方法采用随机、双盲研究方法.经2周的单盲、安慰剂导入期,72例坐位舒张压在95～115mmHg之间的高血压患者被随机分入厄贝沙坦75mg/天组(n=36)或氯沙坦50mg/天组(n=36).4周末,如坐位舒张压仍≥90mmHg,每日剂量加倍(厄贝沙坦150mg/天或氯沙坦100mg/天),总疗程8周.结果两组患者服药后血压均显著降低(P<0.01).经8周治疗,厄贝沙坦组平均坐位收缩压与舒张压分别降低15.0%与13.3%,在氯沙坦组分别为13.7%与14.0%.两药的有效率无显著性差别(厄贝沙坦75.0%,氯沙坦71.4%,P>0.05).与厄贝沙坦不同,氯沙坦组血尿酸水平显著降低.结论在轻中度高血压的治疗中,厄贝沙坦与氯沙坦一样有效与安全.     

伊贝沙坦对原发性高血压患者血浆内皮素及循环内皮细胞的影响

目的观察血管紧张素Ⅱ受体拮抗剂伊贝沙坦治疗原发性高血压患者对血浆内皮素1(ET-1)及循环内皮细胞(CECs)的影响。方法入选50例1~2级原发性高血压患者,经2周安慰剂洗脱期后,给予伊贝沙坦150mg/d,治疗4周,如血压得到控制(收缩压<140mmHg和舒张压<90mmHg),继续原剂量治疗4周;如血压未得到控制[收缩压≥140mmHg和(或)舒张压≥90mmHg],将药物剂量加倍继续治疗4周,观察血浆ET-1、CECs及血压的变化。结果50例患者均完成试验,口服伊贝沙坦2周末血压明显下降[治疗前:(154.0±12.8/96.3±2.0)mmHgvs治疗后(130.4±10.8/84.5±9.5)mmHg,P<0.01],治疗2、4、6、8周末血压间无明显差异;与治疗前比较,治疗后血浆ET-1和CECs显著下降[ET-1:治疗前(37.5±9.5)vs治疗后(29.7±12.1)ng/L,P<0.01;CECs:治疗前(6.7±3.6)vs治疗后(4.4±2.8)106cells/L,P<0.01]。结论对于轻中度原发性高血压患者,伊贝沙坦有效降压的同时改善血管内皮功能。     

氯沙坦对糖尿病合并原发性高血压患者内皮细胞功能的影响

目的观察血管紧张素Ⅱ受体拮抗剂氯沙坦对糖尿病合并高血压患者内皮细胞功能及其分泌因子的影响。方法入选48例糖尿病合并1～2级高血压患者,给予氯沙坦50mg／d治疗4周,如血压未得到控制[收缩压≥140mmHg和（或）舒张压≥90mmHg],将药物剂量加倍继续治疗4周。采取静脉血测定治疗前、后血浆降钙素基因相关肽（CGRP）、一氧化氮（NO）、前列环素（PGI2）、内皮素（ET）、血管紧张素Ⅱ（AngⅡ）水平及血压的变化。结果31例治疗2周末血压降至正常,收缩压（162．3±23．8）mmHg比（131．5±17．3）mmHg（P〈0．05）,舒张压（106．4±14．9）mmHg比（85．3±13．5）mmHg（P〈0．01）,其后血压稳定。治疗4周后血浆CGRP和PGI2显著升高,分别为（117．3±19．5）ng／L比（164．2±23．1）ng／L（P〈0．01）和（116．6±69．1）pg／ml比（223．5±84．9）pg／ml（P〈0．01）;血浆AngⅡ水平显著降低[（539．8±226．2）pg／ml比（441．3±161．1）pg／ml,P〈0．05]。其余17例治疗4周后,因收缩压或舒张压未降至正常水平,药量加倍再治疗4周,血压显著下降,收缩压（167．2±21．7）mmHg比（144．2±13．5）mmHg,P〈0．05,舒张压（112．7±13．7）mmHg比（96.3±12．1）mmHg,P〈0．01;血浆CGRP水平显著升高[（112．7±13．7）ng／L比（171．6±37．1）ng／L,P〈0．05],和健康人水平[（178．1±34．7）ng／L]差异无统计学意义（P〉0．05）。结论氯沙坦是一种安全有效的降压药物,同时可以改善糖尿病合并高血压患者血管内皮细胞功能。     

氯沙坦联用氢氯噻嗪对高血压合并高尿酸血症患者的治疗效果

目的:探讨氯沙坦联用氢氯噻嗪对高血压合并高尿酸血症患者血压和血尿酸的影响。方法:入选诊断为原发性高血压合并高尿酸血症,且口服氯沙坦100 mg/d4周以上血压未达标的患者55例,改为每日口服氯沙坦50 mg和氢氯噻嗪12.5 mg复方制剂,共12周。观察药物联合治疗前后患者血压和血尿酸水平的变化。结果:氯沙坦联合氢氯噻嗪治疗后,患者平均收缩压、平均舒张压水平明显下降,分别为(148±11)mmHg对(133±14)mmHg和(91±8)mmHg对(84±9)mmHg(P<0.001),而血尿酸水平无显著变化。结论:对于单用氯沙坦降压效果不显著的高血压合并高尿酸血症患者,氯沙坦联用氢氯噻嗪可明显降低血压水平,且对血尿酸水平无显著影响。     

伊贝沙坦治疗轻中度高血压疗效和安全性的临床研究

目的为评价新一代血管紧张素Ⅱ AT1受体拮抗剂伊贝沙坦(安博维)降压疗效及安全性,并与氯沙坦相比较.方法采用随机分组平行对照方法,将120例轻、中度高血压患者分成伊贝沙坦组(60例),口服150mg*d-1和氯沙坦组(60例),口服50 mg*d-1.观察8周.每2周一次上午延迟1～4小时用药并测诊室谷值坐位血压、心率,并观察不良反应.用药前及治疗第4周和第8周检测血液生化.第4周谷值坐位血压仍大于90 mmHg者加用双氢克尿噻12.5 mg*d-1.结果第4周伊贝沙坦与氯沙坦正常化率分别为40%和35%,第8周伊贝沙坦与氯沙坦组血压有效反应率分别为78.3%和66.7%,(P＞0.05) .两组治疗前、后平均谷值坐位舒张压有显著性差异P＜0.01.伊贝沙坦组不良反应发生率6.6%,氯沙坦组为8.3% (P>0.05).两组部分病例加用小剂量双氢克尿噻后,谷值坐位舒张压进一步下降.谷值坐位舒张压下降幅度,伊贝沙坦组优于氯沙坦组,P＜0.05.结论伊贝沙坦与氯沙坦不良反应发生率均较低,伊贝沙坦降低谷值坐位舒张压更有效.建议生产伊贝沙坦与小剂量双氢克尿噻的复方制剂.     

伊贝沙坦对高血压病伴高尿酸血症的干预作用

目的：探讨伊贝沙坦对高血压病伴高尿酸血症患者的干预作用。方法：高血压病伴高尿酸血症患者80例，随机分成伊贝沙坦组40例，给予伊贝沙坦300mg／d；常规治疗组40例，给予钙拮抗剂或B受体阻滞剂等，排除对血尿酸代谢有影响的药物ACEI及利尿剂等。治疗6周后观察收缩压（SBP）、舒张压（DBP）、血尿酸（UA）、尿素氮（BUN）、肌酐（Cr）、尿微量白蛋白（MA）变化。结果：伊贝沙坦组和常规治疗组SBP、DBP和治疗前比均显著下降（P〈0．01）。伊贝沙坦治疗组血UA、BUN、Cr及尿MA水平分别由治疗前（448．1±50．8）μmol／L、（10．7±1．3）mmol／L、（149．1±13．8）μmol／L、（57．1±17．4）mg／L下降至（367．9±42．9）μmol／L、（8．2±1．0）mmol／L、（120．9±11．5）μmol／L、（44．6±13．7）mg／L（P均〈0．01），而常规治疗组血UA、BUN、Cr及尿MA水平下降无显著性差异（P〉0．05）。结论：伊贝沙坦能有效地降低高血压病患者的血压同时还具有降血尿酸及肾脏保护作用。     

当归拈痛汤加减治疗高血压合并高尿酸血症的疗效观察

目的探讨当归拈痛汤治疗1级高血压合并高尿酸血症患者的疗效。方法入选65例原发性1级高血压合并高尿酸血症患者,随机分为中药治疗组和对照组。32例对照组给口服别嘌醇片每日1次,每次一粒(100mg);中药治疗组33例在口服别嘌醇的基础上加服当归拈痛汤加减方。连续治疗8周后观察诊室血压、动态血压、血清尿酸及血浆血管紧张素Ⅱ(AngⅡ)等变化。结果与治疗前比较,治疗后两组诊室平均收缩压、平均舒张压、24h平均收缩压、24h平均舒张压、血清尿酸、AngⅡ都较前降低(P0.01)。与对照组比较,中药治疗组诊室平均收缩压、平均舒张压、24h平均收缩压、24h平均舒张压、血清尿酸、AngⅡ下降程度优于对照组(P0.05)。结论中药当归拈痛汤在有效降低1级高血压合并高尿酸血症患者的诊室血压、24小时动态血压,其可能与当归拈痛汤有效降低尿酸、血浆AngⅡ,从而抑制RAAS相关。     

Effects of losartan and irbesartan on serum uric acid in hypertensive patients with hyperuricaemia in Chinese population

Therapy with losartan compared to irbesartan was performed in a Chinese sample of hypertensive patients with elevated serum uric acid (SUA) levels. After 1 week of screening and a 2 week single-blinded placebo baseline period, patients were treated for 4 weeks with losartan 50 mg or irbesartan 150 mg. After 4 weeks, patients with SiDBP <90 mmHg and SiSBP <140 mmHg continued the same dose regimen for another 4 weeks. If blood pressure was not controlled after 4 weeks of treatment, the dose of either regimen was doubled to losartan 100 mg and irbesartan 300 mg. There were 351 patients randomized (176 to losartan and 175 to irbesartan), and of these, 325 patients completed the study (162 in the losartan group and 163 in the irbesartan group). At baseline, the median SUA level in the losartan group was 422 and 420 micromol/l in the irbesartan group. At 8 weeks of therapy, SUA decreased by 63 mumol/l in the losartan group compared to 12 mumol/l in the irbesartan group (P < 0.0001). Blood pressure declined comparably in both groups from 151/92 mmHg at baseline to 137/83 and 135/83 (losartan and irbesartan, respectively, NS). No severe AEs were found for either treatment group. Therapy with losartan decreased SUA levels significantly more than irbesartan in Chinese patients with hypertension and elevated SUA levels, demonstrating the unique uricosuric effect of this ARB in this ethnic group.     

A comparison of the efficacy and safety of irbesartan/HCTZ combination therapy with irbesartan and HCTZ monotherapy in the treatment of moderate hypertension

This prospective, double-blind, parallel-group study randomized patients with moderate hypertension (seated systolic blood pressure (SeSBP) 160-179 mm Hg when seated diastolic blood pressure (SeDBP) <110 mm Hg; or SeDBP 100-109 mm Hg when SeSBP <180 mm Hg) 3:1:1 to treatment with irbesartan 300 mg/hydrochlorothiazide (HCTZ) 25 mg combination therapy (n=328), irbesartan 300 mg monotherapy (n=106) or HCTZ monotherapy 25 mg (n=104). Treatment was initiated at half dose, with forced titration to full dose after two weeks followed by ten further weeks' treatment. The primary efficacy variable was the mean reduction in SeSBP from baseline to week 8. Baseline characteristics were similar between groups, with mean baseline blood pressure approximately 162/98 mm Hg; the mean age was 55 years. At week 8 there was a reduction in SeSBP of 27.1 mm Hg with irbesartan/HCTZ, compared with 22.1 mm Hg with irbesartan monotherapy (P=0.0016) and 15.7 mm Hg with HCTZ (P<0.0001). Both the rate of decline and the total degree of decline achieved were greatest with irbesartan/HCTZ and least with HCTZ. A significantly greater percentage of patients reached a treatment goal of SeSBP <140 mm Hg and SeDBP <90 mm Hg by week 8 with irbesartan/HCTZ (53.4%), compared with irbesartan (40.6%; P=0.0254) and HCTZ (20.2%; P<0.0001) alone. Treatment was well tolerated in all three-treatment groups with a slight increase in adverse events in the combination therapy group. In conclusion, irbesartan/HCTZ (300/25 mg) is well tolerated and achieves rapid and sustained reductions in both systolic blood pressure and diastolic blood pressure in patients with moderate hypertension.     

Effect of losartan versus candesartan on uric acid, renal function, and fibrinogen in patients with hypertension and hyperuricemia associated with diuretics

BACKGROUND: Hyperuricemia may counter benefits of blood pressure (BP) reduction, although this is controversial. METHODS: We examined the effects of candesartan and losartan on uric acid, creatinine, and fibrinogen. Patients with hypertension and serum uric acid > or = 0.42 mmol/L (7 mg/dL) associated with diuretics were randomized to receive losartan 50 to 100 mg or candesartan 8 to 16 mg for 24 weeks. At randomization and after 24 weeks, systolic and diastolic BP, serum uric acid, creatinine, and fibrinogen were measured. RESULTS: A total of 59 patients were entered into the study (30 in the losartan and 29 in the candesartan group). Mean systolic and diastolic BP were reduced in the candesartan group, from 156 mm Hg at baseline to 132 mm Hg at 24 weeks, and from 90.9 to 80.8 mm Hg respectively, P < .0001), and in the losartan group from 150.3 to 132 mm Hg and from 89.6 to 77.6 respectively, P < 0001). Overall mean values of fibrinogen levels were again reduced from 4.39 g/L at baseline to 4.01 g/L at 24 weeks (P < .02). Mean values of serum uric acid in the losartan and candesartan groups were similar at baseline (0.44 and 0.46 mmol/L, respectively), but they were lower in the losartan group after 24 weeks (0.39 and 0.48 mmol/L, P = .01). Twelve patients (44%) in the candesartan group had a 10% increase in serum creatinine compared with four patients (14.2%) in the losartan group (P < .02). CONCLUSIONS: Candesartan and losartan lowered BP, but only losartan reduced uric acid. The lowering of fibrinogen in both groups may explain the reduction in stroke with angiotensin receptor blockers. The effect of persistent hyperuricemia on renal function requires further study.     

奥美沙坦酯与氯沙坦钾治疗中国轻、中度原发性高血压患者8周的疗效与安全性比较

目的 通过与氯沙坦钾比较评价奥美沙坦酯治疗轻、中度原发性高血压患者的疗效和安全性。方法采用随机、双盲、双模拟、阳性对照、平行分组、多中心临床试验方法。共入选287例轻、中度原发性高血压患者,按照1：1的比例随机分组,分别接受奥美沙坦酯20mg或氯沙坦钾50mg,每天1次口服治疗。在用药4周后对患者进行血压评价,如果患者舒张压（DBP）仍≥90mmHg（1mmHg=0．133kPa）,则试验药物剂量加倍,直至8周试验结束;治疗4周后DBP〈90mmHg的患者则维持原剂量继续治疗至第8周。结果（1）治疗4周后,奥美沙坦酯组坐位DBP谷值平均下降11．72mmHg,氯沙坦钾组平均下降9．23mmHg,两组间比较P=0．004。（2）治疗8周后,奥美沙坦酯组坐位DBP谷值平均下降12．94mmHg,氯沙坦钾组平均下降11．01mmHg,两组间比较P=0．035。（3）治疗4周后,奥美沙坦酯组有效数为81例（65．3％）,氯沙坦钾组有效数为68例（52．7％）,两组间比较P=0．028;治疗8周后,两组有效病例数和有效率相当,P〉0．05。（4）治疗8周后,24h动态血压监测显示,奥美沙坦酯组DBP和SBP的个体和总体谷／峰比值均高于氯沙坦钾组,奥美沙坦酯在24h内的作用持续时间比氯沙坦钾组长。（5）奥美沙坦酯组和氯沙坦钾组发生的与试验药物有关的不良事件的发生率分别为10．5％和13．9％,P〉0．05。结论奥美沙坦酯每日口服20～40mg能够有效、安全地治疗高血压。与氯沙坦钾每日口服50-100mg相比,奥美沙坦酯的降压效果优于氯沙坦钾。     

Comparative efficacy of olmesartan, losartan, valsartan, and irbesartan in the control of essential hypertension

In a multicenter, randomized, double-blind trial, the authors compared the antihypertensive efficacy of once-daily treatment with the new angiotensin II type 1 receptor blocker (ARB) olmesartan (20 mg) with recommended starting doses of losartan (50 mg), valsartan (80 mg), and irbesartan (150 mg) in 588 patients with a cuff diastolic blood pressure (DBP) of ≥100 and ≥115 mm Hg and a mean daytime DBP of ≥90 mm Hg and <120 mm Hg, as measured by ambulatory blood pressure monitoring. Cuff and ambulatory blood pressures were monitored at baseline and after 8 weeks of treatment. All groups were predominantly white and approximately 62% male, and their mean age was approximately 52 years. In all groups, mean baseline DBP and systolic blood pressure (SBP) were approximately 104 and 157 mm Hg, respectively. The reduction of sitting cuff DBP with olmesartan (11.5 mm Hg), the primary efficacy variable of this study, was significantly greater than with losartan, valsartan, and irbesartan (8.2, 7.9, and 9.9 mm Hg, respectively). Reductions of cuff SBP with the four ARBs ranged from 8.4–11.3 mm Hg and were not significantly different. The reduction in mean 24-hour DBP with olmesartan (8.5 mm Hg) was significantly greater than reductions with losartan and valsartan (6.2 and 5.6 mm Hg, respectively) and showed a trend toward significance when compared to the reduction in DBP with irbesartan (7.4 mm Hg; p=0.087). The reduction in mean 24-hour SBP with olmesartan (12.5 mm Hg) was significantly greater than the reductions with losartan and valsartan (9.0 and 8.1 mm Hg, respectively) and equivalent to the reduction with irbesartan (11.3 mm Hg). All drugs were well tolerated. The authors conclude that olmesartan, at its starting dose, is more effective than the starting doses of the other ARBs tested in reducing cuff DBP in patients with essential hypertension.     

厄贝沙坦与美托洛尔的联合方案对男性高血压患者性功能的影响

目的 探讨非洛地平联合厄贝沙坦或美托洛尔两种降压方案对男性高血压病患者性功能的影响.方法 123例高血压病患者随机分为两组:非洛地平(5 mg/d)+厄贝沙坦(150 mg/d)组(F+I组,64例);非洛地平(5 mg/d)+琥珀酸美托洛尔(47.5 mg/d)组(F+M组,59例).监测患者血压变化;治疗第0、24周用国际男性性功能问卷(IIEF)评价患者的性功能,同时用放射性免疫法测血清睾酮和性激素结合蛋白、硫代巴比妥酸法测丙二醛、ELISA 法测8-羟基脱氧鸟苷和4-羟基壬烯酸.结果 F+I组治疗后性欲积分值增高(P<0.05),轻度勃起功能障碍患者的勃起功能评分增加;勃起功能障碍患者8-羟基脱氧鸟苷治疗前、后分别为(146.02±60.54)ng/L比 (139.89±62.03)ng/L,丙二醛治疗前、后分别为(6.59±1.75)μmol/L比(6.01±1.65)μmol/L,治疗前后比较差异有统计学意义(P<0.05).两组治疗前后血压达标率、有效率、勃起功能障碍的发生率、睾酮、性激素结合蛋白、4-羟基壬烯酸差异均无统计学意义(P>0.05).结论 相对于F+M组,F+I组可能更有益于男性高血压病患者性功能,但这种获益是否与该组治疗后患者氧化应激状态的改变有关,尚待进一步的研究.

Abstract：

Objective To compare the effects of felodipine combined irbesartan regimen with that of felodipine combined metoprolol regimen on the sexual function in male hypertensive patients. Method One handred and twenty-three male hypertensive paitients (age 25 to 60) were randomly assigned to felodipine (5 mg/d) plus irbesartan ( 150 mg/d, n=64) group and felodipine (5 mg/d) plus metoprolol (47.5 mg/d, n=59) group. Dosage of felodipine were doubled after 4 weeks if the blood pressure were ≥140/ 90 mm Hg (1 mm Hg=0.133 kPa). At the baseline and post 24th week treatment, sexual function of patients was assessed by the International Index of Erectile Function (IIEF) Questionaire. Serum testosterone (T), sex hormone binding globulin (SHBG), 4-hydroxynonenal (HNE), 8-hydroxy-2′-deoxyguanosine (8-OHdG) and Malonaldehyde (MDA) were measured by Radioimmunoassay (RIA), ELISA and TBA respectively. Results Total prevalence of erectile dysfunction (ED),T, SHBG and HNE were similar between pre- and post-treatment in two groups (P>0.05). On the other hand, the scores of the mild ED and sexual desire (SD) were improved and both serum 8-OHdG and MDA in patients with ED decreased [(146.02±60.54)ng/L vs. (139.89±62.03)ng/L, P=0.048 and (6.59±1.75)μmol/L vs. (5.51±1.65)μmol/L,P=0.039] in Felodipine plus Irbesartan group. Conclusion The results suggested that Felodipine + Irbesartan regimen may be superior to Felodipine + metoprolol regimen for male hypertensive patients with mild ED.     

噻嗪类利尿剂、氯沙坦及其复方制剂对高血压患者的血清尿酸水平的影响

目的 观察原发性高血压病(EH)患者高尿酸血症的流行情况,以及噻嗪类利尿剂、血管紧张素受体拮抗剂氯沙坦和氯沙坦+氢氯噻嗪6周降压治疗后EH患者血清尿酸(SUA)和电解质的变化.方法 收集福州4家医院近3年连续的EH患者共1080例,其中男女之比662:418,平均年龄(60.9±12.3)岁,治疗前后血压记录完整者1000例,肾功能和电解质完整者600例.结果 EH患者合并高尿酸血症的发生率为25.83%(279/1080),与EH组比较,EH合并高尿酸血症组患者体质指数、肌酐升高,内生肌酐清除率降低(P分别<0.05和0.01).降压治疗6周末69.40%(694/1000)患者收缩压<140 mm Hg(1 mm Hg=0.133 kPa),85.30%(853/1000)患者舒张压<90 mm Hg.不同降压药物治疗后SUA和血钾的变化:低剂量利尿剂组SUA平均升高(43.81±71.79)μmol/L(P<0.0001),氯沙坦组平均下降(44.96±90.63)μmol/L(P<0.01,100 mg组优于50 mg组),氯沙坦+氢氯噻嗪组平均下降(7.46±84.72)μmol/L,三组药物治疗后SUA之间的差异有统计学意义;低剂量利尿剂组血钾平均下降(0.30±0.44)mmol/L(P<0.01),与氯沙坦组[(0.06±0.43)mmol/L]和氯沙坦+氢氯噻嗪组[(-0.04±0.44)mmol/L]比较,差异也有统计学意义.结论 EH患者25.83%合并高尿酸血症;高血压合并高尿酸血症者有体质指数增加和肾功能损害趋势;低剂量噻嗪类利尿剂会加重SUA增高和低血钾,氯沙坦可剂量依赖性的降低SUA,而氯沙坦+氢氯噻嗪介于两者之间.     

The efficacy and safety of low- and high-dose fixed combinations of irbesartan/hydrochlorothiazide in patients with uncontrolled systolic blood pressure on monotherapy: the INCLUSIVE trial

This multicenter, prospective, open-label, single-arm study determined the efficacy and safety of irbesartan/hydrochlorothiazide (HCTZ) fixed combinations in patients (n=1005), aged 18 years and older, with uncontrolled systolic blood pressure (SBP) of 140-159 mm Hg (130-159 mm Hg for type 2 diabetes mellitus) after at least 4 weeks of antihypertensive monotherapy. Treatment was sequential: placebo (4-5 weeks), HCTZ 12.5 mg (2 weeks), irbesartan/HCTZ 150/12.5 mg (8 weeks), and irbesartan/HCTZ 300/25 mg (8 weeks). Enrolled patients (n=844) were aged 57.3+/-11.2 years; 52% were women, 23% were African American, and 14% were Hispanic. Thirty percent had type 2 diabetes mellitus, 46% had metabolic syndrome, and baseline blood pressure was 154.0+/-10.3/91.3+/-8.8 mm Hg. The mean change in SBP from placebo end to the primary end point, Week 18 (intent-to-treat population, n=736) was -21.5+/-14.3 mm Hg (p<0.001). The mean change in diastolic blood pressure (DBP) was -10.4+/-8.7 mm Hg (p<0.001). The mean Week 18 SBP/DBP was 132.9+/-13.8/81.1+/-9.7 mm Hg. Overall, 77% (95% confidence interval, 74%-80%) of patients achieved SBP goal (<140 mm Hg; <130 mm Hg for type 2 diabetes mellitus); 83% (95% confidence interval, 80%-86%) achieved DBP goal (<90 mm Hg; <80 mm Hg for type 2 diabetes mellitus); and 69% (95% confidence interval, 66%-72%) achieved dual SBP/DBP goal. Treatments were well tolerated. This irbesartan/HCTZ treatment regimen achieved SBP goals in more than 75% of patients uncontrolled on monotherapy.     

Antihypertensive efficacy of Irbesartan/HCTZ in men and women with the metabolic syndrome and type 2 diabetes

This subgroup analysis of the Irbesartan/Hydrochlorothiazide (HCTZ) Blood Pressure Reductions in Diverse Patient Populations (INCLUSIVE) trial evaluated the efficacy and safety of irbesartan/HCTZ fixed combinations in adults with uncontrolled systolic blood pressure (SBP) (140-159 mm Hg; 130-159 mm Hg for type 2 diabetes mellitus [T2DM]) after >or=4 weeks of antihypertensive monotherapy. Treatment was sequential: placebo (4-5 weeks), HCTZ 12.5 mg (2 weeks), irbesartan/HCTZ 150/12.5 mg (8 weeks), and irbesartan/HCTZ 300/25 mg (8 weeks). In the intent-to-treat analysis, mean change from baseline (end of placebo phase) off all previous therapy to Week 18 (study end) in T2DM patients (n=227) was -18.2+/-14.1 mm Hg for SBP (primary end point; p<0.001) and -8.7+/-8.2 mm Hg for diastolic blood pressure (p<0.001). Mean SBP/diastolic blood pressure changes in patients with the metabolic syndrome (n=345) were -21.0+/-14.3/-10.4+/-8.5 mm Hg (p<0.001). Overall, 56% (95% confidence interval, 49%-62%) of T2DM and 73% (95% confidence interval, 68%-77%) of metabolic syndrome patients achieved SBP goal (<140 mm Hg; <130 mm Hg for T2DM). Goal attainment rates were significantly higher among women with the metabolic syndrome than men. Treatments appeared to be well tolerated. Irbesartan/HCTZ fixed combinations achieved SBP goals in over half of the T2DM patients and nearly three quarters of patients with the metabolic syndrome, with SBP uncontrolled on antihypertensive monotherapy.     

Blood pressure outcomes in patients receiving angiotensin II receptor blockers in primary care: a comparative effectiveness analysis from electronic medical record data

The authors examined the comparative effectiveness of 4 angiotensin receptor blockers (ARBs) in patients with hypertension using a large electronic medical record database. Analysis of covariance and logistic multivariate regression models were used to estimate the blood pressure (BP) outcomes of 73,012 patients during 13 months of treatment with olmesartan, losartan, valsartan, and irbesartan. Results were adjusted by baseline BP, starting dose, year, age, sex, race, body mass index, comorbid conditions, and concomitant medications of patients. All ARBs led to sustained reductions in BP, but with significant differences in the magnitude of BP reduction. Raw mean systolic BP/diastolic BP reductions with losartan, valsartan, irbesartan, and olmesartan were 9.3/4.9 mm Hg, 10.4/5.6 mm Hg, 10.1/5.3 mm Hg, and 12.4/6.8 mm Hg, respectively. Adjusting for all covariates, the overall BP reductions with olmesartan were 1.88/0.86 mm Hg, 1.21/0.52 mm Hg, and 0.89/0.51 mm Hg greater than for losartan, valsartan, and irbesartan, respectively, and mean differences were higher for monotherapy: 2.43/1.16 mm Hg; 2.18/0.93 mm Hg; 1.44/0.91 mm Hg, respectively (all P values <.0001). Adjusted odds ratios of the JNC 7 goal attainment for losartan, valsartan, and irbesartan compared with olmesartan were 0.76, 0.86, and 0.91 (P<.05). Differences were also found in subpopulations: African Americans, diabetics, and obese/overweight patients but not all of these reached statistical significance. A broad choice of ARBs may be required to get patients to treatment goals.