氯沙坦对高血压病人部分血管活性肽的影响

目的 :观察氯沙坦降压疗效及其对部分血管活性肽的影响。方法 :4 7例轻、中度高血压病人予氯沙坦 5 0～ 10 0mg ,po ,qd× 4wk ,观察其血压变化 ,并测定血浆血管紧张肽II(AngII)、内皮素(ET)、心钠素 (ANF)和降钙素基因相关肽 (CGRP)治疗前后的变化。结果 :治疗 4wk后 ,高血压病人血压明显下降 (P <0 .0 1)。AngII治疗前后为 (10 3±s 5 0 )ng·L- 1和 (15 0± 85 )ng·L- 1(P <0 .0 1) ,CGRP分别为 (30± 17)ng·L- 1和 (4 5± 18)ng·L- 1(P <0 .0 1) ,均较治疗前升高。ANF则较治疗前降低 ,分别为 (2 75± 17)ng·L- 1和 (186± 7)ng·L- 1(P<0 .0 1)。而血浆ET治疗前后无显著变化 (P >0 .0 5 )。结论 :氯沙坦具有平稳的降压疗效 ,并能影响部分血管活性肽的异常分泌     

新型抗高血压药物氯沙坦

氯沙坦是血管紧张素Ｉ受体拮抗剂中的代表药物，具有作用广泛、降压作用显著、服药方便、对肾功能影响小、副作用小等优点。     

美托洛尔对高血压患者肾素系统活性的影响

目的研究美托洛尔的降压疗效及其对肾素-血管紧张素-醛固酮系统及血管内皮功能的影响。方法对49例初诊原发性高血压患者口服美托洛尔4周。观察治疗前后血压及血浆肾素、血管紧张素、醛固酮、内皮素和一氧化氮浓度的变化。结果美托洛尔治疗4周后,诊室收缩压和舒张压的下降幅度分别为16．70mmHg和7．52mmHg（P〈0．01）;肾素、血管紧张素、醛固酮降低,一氧化氮水平升高（P〈0．05）;而内皮素、一氧化氮／内皮素比值无明显变化。结论美托洛尔能够有效的抑制肾素、血管紧张素、醛固酮系统及改善血管内寿功能,达到降低血压和保护靶器它的目的．     

氯沙坦对高血压患者血管活性物质的影响

目的观察氯沙坦对高血压患者的降压效果及其对血管活性物质的影响。方法选用30例正常血压的健康者和35例原发性高血压患者,两组均测定血压、肾素-血管紧张素(RAS)、醛固酮(ALD)、内皮素(ET)、去甲肾上腺素(NE);后者用氯沙坦治疗8周后复查上述指标。结果高血压患者有高的肾素(PRA)、血管紧张素Ⅱ(AngⅢ)、ALD、ET和NE,氯沙坦有明显的降压作用,其降压的同时可致:PRA治疗前(0·82±0·04)nmol/L,治疗8周后(1·31±0·41)nmol/L(P<0·05);AngⅡ治疗前(122±16·38)ng/L,治疗8周后(245±0·47)ng/L(P<0·05);ALD治疗前(1·20±0·47)nmol/L,治疗8周后(0·44±0·15)nmol/L(P<0·05),ET治疗前(101·39±24·62)ng/L,治疗8周后(43·55±13·57)ng/L(P<0·05);NE治疗前(0·86±0·09)ng/ml,治疗8周后(0·66±0·04)ng/ml(P<0·05)。结论氯沙坦是一种安全有效的降压药。其可通过阻断AngⅡ与受体结合的作用,改善血管内皮细胞的功能,降低交感神经的活性等机制使血压下降。     

氯沙坦对高血压患者AⅡ及纤溶活性的影响

近年研究表明,纤溶系统异常及肾素—血管紧张素系统(ＲＡＳ)激活在高血压病(ＥＨ)的病理过程中起着重要作用。本文观察29例ＥＨ患者氯沙坦治疗前后组织型纤溶酶原激活物(ｔＰＡ)及其抑制物(ＰＡＩ—1)及血管紧张素Ⅱ(ＡⅡ)和醛固酮(ＡＬＤ)水平变化,并与正常对照组进行比较,旨在探讨氯沙坦对ＥＨ患者纤溶活性及ＡⅡ、ＡＬＤ的影响。1　对象与方法11　对象　29例ＥＨ患者均为我院1998年9月至1999年12月内科住院病人,男14例,女15例。年龄40～83岁,平均(6348±893)岁。ＥＨ病的诊断及分期按1978年ＷＨＯ标准。Ⅰ期7例,Ⅱ期22例。摒除Ⅲ期高血压…     

氯沙坦对自发性高血压大鼠内皮素和肾素-血管紧张素水平的对照研究

目的：动物实验观察氯沙坦的降压效果及其对血浆内皮素（ET），肾素活性和血管紧张素Ⅱ（AngⅡ)的影响。方法：24只雄性16周龄的自发性高血压大鼠（SHR）分为生理盐水（NS）组，氯沙坦（L）组和西拉普利（C）组，另用8只同龄雄性WKY大鼠对照，观察用药12周前后的血压，ET，肾素活性和AngⅡ水平。结果：与NS，C组比较，氯沙坦降压效果明显，与NS组比较，血浆ET水平在L组和C组均有明显下降，血浆肾素活性在L组明显升,AngⅡ水平，L组明显升高，而C组有所下降，结论：氯沙坦和西拉普利具有相似的降压效果。氯沙坦和西拉普利均使血管内皮细胞分泌的ET减少，西拉普利使AngⅡ水平降低，而氯沙坦使血浆AngⅡ水平升高，较高的血浆AngⅡ水平对组织器官的影响，有待进一步研究。     

福辛普利和氯沙坦治疗心力衰竭疗效的比较

目的 :比较福辛普利和氯沙坦治疗心力衰竭的疗效及对肾素血管紧张肽系统的影响。方法 :71例心力衰竭病人分为 2组 ,其中 36例病人应用福辛普利 10mg ,qd× 4wk ,35例病人应用氯沙坦50mg ,qd× 4wk。结果 :福辛普利组临床总有效率为 61% ,氯沙坦组为 63% (P >0 .0 5)。 2组治疗前后心率、血压的差值分别为 ( 12± 12 )次·min- 1和 ( 7± 10 )次·min- 1,( 2 .9± 2 .2 ) / ( 4± 3)kPa和 ( 2 .6±0 .9) / ( 3.6± 2 .0 )kPa(均P <0 .0 1)。同时 2组均有减少心肌氧耗、改善心肌缺血范围和程度、改善左室收缩舒张功能等作用。结论 :尽管 2药对肾素血管紧张肽系统作用不同 ,但均对治疗心力衰竭有效     

辛伐他汀对一氧化氮缺乏性高血压大鼠心脏局部肾素血管紧张素系统的影响

目的：观察辛伐他汀对一氧化氮（NO）缺乏性高血压大鼠心脏局部肾素－血管紧张素系统（RAS）的影响。方法：24只Wistar大鼠随机分为正常对照组（C组）、硝基精氨酸甲酯（L－NAME）组（L组）和L－NAME＋辛伐他汀组（L＋S组）。每2wk尾袖法测定动脉收缩压，8wk后测定血清甘油三酯（TG）、总胆固醇（TC）及血清和心肌组织血管紧张素Ⅱ（AngⅡ）水平、血管紧张素转移酶（ACE）活性。结果：L组大鼠血压与同期C组血压相比有极显性差异（P＜0．01），辛伐他汀干预未对增高的血压产生明显影响（P＞0．05）；各组大鼠血清TG和TC水平比较也无显性差别（P＞0．05）。与C组相比，L组大鼠血清ACE活性明显降低（P＜0．01），L组和L＋S组大鼠血浆AngⅡ水平与C组比较无显性差异（P＞0．05），心肌组织中AngⅡ水平和ACE活性则较C组明显增高（P＜0．01）；辛伐他汀干预后L＋S组大鼠血清ACE活性升高，但与L组无显性差异（P＞0．05），心肌ACE活性和AngⅡ水平则均比L组明显降低（P＜0．05）。结论：辛伐他汀可能通过降低局部心肌组织ACE活性抑制NO缺乏性高血压大鼠心脏局部RAS活性，减少AngⅡ生成，这种作用独立于调脂和降压作用之外。     

自发性高血压大鼠主动脉平滑肌细胞异常增殖和局部肾素—血管？…

目的：探讨ＳＨＲ大鼠主动脉平滑肌细胞（ＡＳＭＣ）异常增殖和肾素－血管紧张素系统９ＲＡＳ）的关系。方法：测定血管紧张素Ⅱ（Ａｎｇ）、卡托普利（Ｃａｐ）、沙拉新（Ｓａｒ）对培养的ＳＨＲ、ＷＫＹ ＡＳＭＣ增殖的Ａｎｇ、血管紧张素转化酶（ＡＣＥ）的影响，结果：Ａｎｇ在２％血清培养基中可刺激ＳＨＲ ＡＳＭＣ增生，ＳＨＲ ＡＳＭＣ分裂增殖能力比ＷＫＹ强，ＳＨＲ ＡＳＭＣ ＲＡＳ处于高功能状态。Ｃａｐ长期（４周     

氯沙坦治疗高血压的临床应用

目的 探讨氯沙坦在临床上的降压效果.方法 利用分组对照方法,了解氯沙坦及氯沙坦与其它药合用治疗高血压的疗效.结果 口服氯沙坦后能够稳定地降低血压,还能有效地控制患者清晨高峰期血压,与利尿药合用,降压效果更显著.与螺内酯合用可以延缓急性心肌梗死后的心室重构过程,有效地抑制心肌梗死后的心肌纤维化过程.结论 氯沙坦治疗高血压有确切的疗效,而且不良反应轻微、病人耐受性好、无咳嗽现象发生.     

Beta-adrenergic blockade and plasma renin activity in borderline hypertension

Summary The influence of beta-adrenergic blockade on plasma renin activity (PRA) was studied in normotensive young men with a hyperkinetic circulation (Group A) and in young men with labile borderline hypertension (Group B). PRA in both groups, when supine and after standing upright for twenty minutes, was significantly lower after intravenous propranolol. The postural increase in PRA was significantly smaller during beta-adrenergic blockade, but the difference between supine and upright levels remained significant. Urinary excretion of adrenaline and noradrenaline was elevated in both groups. In borderline hypertensives, the excretion of noradrenaline did not decrease at night as in Group A subjects. The similarity of the response of PRA to beta-adrenergic blockade in both groups suggests that the quantitative contribution of the sympathetic nervous system to the control of renin secretion does not differ in normotensive and hypertensive subjects with a hyperkinetic circulation.     

氯沙坦治疗肺动脉高压的初步探讨

目的：探讨氯沙坦在治疗肺动脉高压中的作用，以评价其对慢性肺源性心脏病（肺心病）的疗效。方法：60例慢性阻塞性肺疾病同时伴有肺动脉高压病人分成两组，均给予常规吸氧、抗感染、祛痰、平喘等治疗。治疗组加服氯沙坦，50mg/次，每日一次。疗程2周。治疗前和2周时测定肺动脉压。结果：两组治疗后肺动脉压均有显著下降（P＜0．01）；治疗组肺动脉压的下降与对照组比较有极显著的差异（P＜0．001），动脉血氧分压的上升与对照组比较有明显差异（P＜0．05）。结论：慢性阻塞性肺疾病急性加重期病人通过常规吸氧、抗感染、祛痰、平喘等治疗可使肺动脉压降低，加用氯沙坦可使肺动脉压下降更为明显，并使动脉血氧分压上升，提示氯沙坦可用于肺心病的治疗。     

氯沙坦对老年高血压者左室肥厚逆转及血浆内皮素水平的影响

目的 :了解氯沙坦对老年高血压性左室肥厚的逆转作用及对血浆内皮素 (ET)水平的影响。方法 :以 2 0例健康老年人为对照组 ,观察单纯高血压 32例 (EH组 )、高血压伴左室肥厚 2 6例 (LVH组 )在每日服氯沙坦 50mg前及 16wk后血压、ET的变化。用超声心动图观察LVH组在用药前后的左室舒张末期内径 (LVDd)、室间隔厚度 (IVST)、左室后壁厚度 (LVPWT)、左室重量 (LVM )、左室重量指数 (LVMI)的变化。结果 :经氯沙坦治疗后 ,EH组、LVH组的平均动脉压 (MAP)及ET水平有显著性下降 ;LVH组的ET水平与LVM ,LVMI呈正相关 ,LVH组在治疗后IVST ,LVPWT ,LVDd ,LVM ,LVMI亦有显著性下降。结论 :氯沙坦对老年高血压病人不仅有良好的降压效果 ,同时具有逆转LVH及降ET的作用     

葛根素联合替米沙坦对肥胖性高血压患者脂肪因子、肾素-血管紧张素系统活性及胰岛素抵抗的影响

目的：观察葛根素联合替米沙坦对肥胖性高血压患者脂肪因子、肾素-血管紧张素系统活性及胰岛素抵抗的影响。方法选取诊治的肥胖性高血压患者160例,随机分为对照组和观察组,每组80例。对照组给予替米沙坦治疗,观察组在对照组基础上加用葛根素治疗,疗程1个月。比较2组体重指数（ BMI）、腰臀比（ W／H）、脂肪因子（脂联素、瘦素、抵抗素）、肾素（PRA）、血管紧张素Ⅱ（AngⅡ）、空腹血糖（FBG）、空腹胰岛素（FLns）、胰岛素抵抗指数（ HOMA-IR）、胰岛素敏感指数（ ISI）变化。结果与对照组比较,观察组治疗后BMI、W／H、瘦素、抵抗素、PRA、AngⅡ、FBG、FLns、HOMA-IR显著降低,脂联素、ISI显著升高,差异均有统计学意义（ P ＜0圹．05）。结论葛根素联合替米沙坦治疗肥胖性高血压能够有效减轻腹型肥胖,调控脂肪因子分泌,抑制肾素-血管紧张素系统的过度激活及改善胰岛素抵抗。     

氯沙坦治疗原发性高血压病的疗效及对昼夜血压的影响

目的：评价氯沙坦（Losartan,Los）治疗高血压病的疗效及安全性。方法：90例原发性高血压病患者随机分为氯沙坦组和氯氯地平组各45例,分别给予氯沙坦50－100mg/d,po和氨氯地平5－10mg/d,po,疗程均为8wk,疗程结束前后行24小时动脉血压监测。结果：2组用药后24h动态血压监测指标均较用药前有显著下降（P＜0．01）,治疗后2组间各项指标差异无统计学意义（P＞0．05）。结论：氯沙坦50－100mg/d治疗轻、中度原发性高血压病疗效确切,耐受性好,其作用与氨氯地平相似。     

Plasma renin activity does not predict the antihypertensive efficacy of chlorthalidone

Summary It has been established that angiotensin II stimulation may limit the antihypertensive potential of diuretic therapy in some patients. It is less clear, however, whether renin-angiotensin II stimulation is the cause of the flat blood pressure dose-response relationship to diuretics. To investigate this, 75 out-patients with essential hypertension were treated with chlorthalidone 12.5, 25 or 50 mg o.d. for 3 weeks, in a double-blind, placebo controlled cross-over study.Chlorthalidone significantly reduced blood pressure in all the groups, a plateau being reached at 25 mg o.d. Similarly, plasma renin activity was increased by each dose level of chlorthalidone, but it showed a different trend, being increased to a comparable extent at 12.5 mg and 25 mg o.d., and still higher at 50 mg o.d. Thus, greater stimulation of renin was coincident with the levelling of the blood pressure response to chlorthalidone. However no significant correlation was found between interindividual plasma renin activity and change in blood pressure, either in the entire series, or in each treatment subset.The data suggest overall that renin stimulation may influence the characteristic dose-hypotensive response relationship to diuretic agents in antihypertensive therapy, but it is unlikely that measurement of individual plasma renin activity will provide an useful guide to the optimal dose of a diuretic agents.The following Centres took part in the multicentre study (Investigator, Co-Investigator):¹Pisa;²Pistoia (G. Bartolomei, G. Pettinà, F. Innocenti);³Pontedera (M.A. Cagianelli, M. Cipriani);⁴San Miniato (G. Cinotti);⁵Carrara (P. Innocenti, M. Diamanti);⁶Castelnuovo G. (C. Loni, F. Bianchini);⁷Seravezza (G. Saba);⁸Pescia (P. Saba, F. Giuntoli);⁹Volterra (L. Papi);¹⁰Roma, Ciba-Geigy Medical Department (M. Montanari)     

Effect of pinacidil on blood pressure,plasma catecholamines and plasma renin activity in essential hypertension

Summary Pinacidil, a new cyanoguanidine derivative, is an antihypertensive agent with arteriolar vasodilating properties, which acts on precapillary resistance vessels. A trial was carried out in 30 patients with essential hypertension WHO I-II. The treatment period was divided into three phases. Hydrochlorothiazide (HCTZ) and amiloride were administered for 4 weeks in Phase 1 and supine and standing blood pressure decreased significantly. During Phase 2 pinacidil was added to HCTZ/amiloride for the following 3 months. A further significant reduction in blood pressure was obtained. In the next period of treatment (Phase 3) patients were divided into two groups. For 1 month Group A (15 patients) received pinacidil alone and Group B (15 patients) received HCTZ/amiloride. Conventional laboratory blood tests in all patients remained unchanged during treatment. Reported side effects during Phase 2 were headache (2 patients), dizziness (3 patients), palpitations (2 patients) and ankle oedema (2 patients). Plasma renin activity was slightly increased at the end both of Phases 1 and 2. Plasma catecholamines were increased but not significantly at the end of Phase 2 as compared to Phase 1. The results indicate that pinacidil is effective in lowering blood pressure in mild to moderate essential hypertension.     

Effect of oral labetalol on plasma catecholamines,renin and aldosterone in patients with severe arterial hypertension

Summary Arterial blood pressure and plasma catecholamines, renin activity and aldosterone concentration in 12 patients with severe essential hypertension were studied before and after combined -and -adrenergic receptor blockade induced by oral labetalol treatment for 2 months. Furosemide in a fixed dose was employed as a basic antihypertensive agent throughout the study. Blood pressure was adequately controlled in only 6 patients. Mean body weight increased by 1.8 kg and there was a rise in body weight which was inversely correlated with the fall in standing mean blood pressure. The mean plasma noradrenaline concentration decreased from 0.30 to 0.20 ng/ml, whereas plasma adrenaline did not change significantly. Plasma renin activity and aldosterone concentration varied greatly, but the mean values did not change significantly. Change in body weight was correlated inversely with changes in plasma noradrenaline and renin. The results suggest that labetalol, through its combined - and -adrenergic receptor blocking action, induces a rise in body weight, probably due to sodium and fluid retention, which partly counterbalances the antihypertensive effect of labetalol, and partly modifies both renin and sympathetic nervous activity.     

Diagnostic evaluation of plasma aldosterone concentration to plasma renin activity ratio in primary aldosteronism

Using the plasma aldosterone concentration to plasma renin activity ratio (PAC/PRA ratio) as the screening test of choice for primary aldosteronism in hypertensive patients, we studied the clinical characteristics and the diagnostic value of PAC/PRA ratio in primary aldosteronism. The plasma aldosterone concentration (PAC) and plasma renin activity (PRA) levels were measured by radioimmunoassay in 902 hypertensive patients from out-patient clinics or hospitals. One hundred and twenty-six suspected primary aldosteronism patients whose PAC/PRA ratio was > 25 ng/dL/ng/mL/hr had a lamellar computed tomography (CT) scan in the adrenal gland and follow-up visits. The proportion of primary aldosteronism in hypertensive patients was 14% (126/902). There were 54 patients with unilateral or bilateral hyperplasia and 25 patients with adenoma according to the CT scan. 39% (49/126) of the patients with primary aldosteronism had hypokalemia. Twenty-five patients received surgical treatment. The efficacy and cure rates were 100% (25/25) and 48% (12/25), respectively. The effective rate of aldactone and the single-drug cure rate were 89% (48/54) and 24% (13/54), respectively. Primary aldosteronism affects over 10% of hypertensive patients in China. The PAC/PRA ratio can be considered as a routine screening test in hypertensives, especially resistant hypertensive patients and a high PAC/PRA ratio is an invaluable index in primary aldosteronism diagnosis. __________ Translated from Chinese Journal of Cardiology, 2006, 34(10): 873–876 [译自: 中华心血맜病杂志]