含利尿剂的降压药对老年高血压患者血钾和尿酸的影响

目的观察使用含利尿剂的降压药对高血压患者血钾和尿酸的影响。方法将服用含利尿剂的降压药治疗的38例老年高血压患者设为研究组,将服用不含利尿剂的降压药治疗的38例老年高血压患者设为对照组,检测两组患者的血压、血钾和尿酸。结果两组患者的血压状况比较,差异无统计学意义(P0.05),但研究组患者的尿酸水平明显高于对照组患者(P0.05),血钾水平明显低于对照组患者(P0.05),低钾血症发生率明显高于对照组患者(P0.05)。结论含利尿剂和不含利尿剂的降压药治疗老年高血压患者均可取得良好疗效,但含利尿剂的降压药物长期使用易导致患者血钾水平降低,尿酸水平升高,并发低钾血症。     

氯沙坦与吲哒帕胺单用和两药联合治疗老年高血压疗效比较

目的观察氯沙坦与吲哒帕胺单独应用或联合用药对原发性高血压患者血压、血钾、血糖、尿酸、血脂的影响。方法将符合诊断标准的150例老年高血压患者电脑随机分为3组，每组50例，进行用药前后自身对照试验，8周后检测各组血压、血钾、血糖、尿酸、血脂值。结果3组治疗后收缩压和舒张压均较前明显降低，联合治疗组降压幅度最大，氯沙坦组和联合治疗组治疗后尿酸值较治疗前降低，吲哒帕胺组治疗后血钾值较治疗前降低。结论氯沙坦与吲哒帕胺联合应用不仅具有协同降压作用，而且能降低尿酸，减轻吲哒帕胺引起的低钾血症。     

低钾血症与脑血管意外发生的关联探讨

目的分析和研究低钾血症与脑血管意外发生的关联。方法选取陕西省康复医院神经外科2015年1月—2018年1月收治的200例脑卒中患者,另外随机选取200例非脑卒中患者作对照,观察两组患者低血钾症发生率、血钾和血钠水平,分析低血钾症的影响因素以及对脑卒中患者预后的影响。结果脑卒中患者低钾血症发生率为57.5%,明显高于非脑卒中组23.5%,脑卒中组平均血钾水平明显低于非脑卒中组,差异有统计学意义(P0.05);脑卒中患者低钾血症与年龄和病情程度有密切的关系,差异有统计学意义(P0.05);脑卒中低钾血症患者预后不良反应发生率为16.52%,明显高于血钾正常患者7.06%,差异有统计学意义(P0.05)。结论脑卒中患者低钾血症比例较高,在脑卒中临床治疗中,应加强对血钾的检测和控制,避免血钾过低导致预后不良。     

老年女性射血分数保留心力衰竭住院患者的临床特点

目的分析老年女性射血分数保留心力衰竭(HFpEF)住院患者的临床特点。方法回顾性调查2016年4月1日～2017年3月31日福建医科大学附属协和医院首次住院的年龄≥65岁的女性心力衰竭患者168例,按LVEF分为HFpEF组(LVEF≥40%)136例和射血分数降低心力衰竭(HFrEF)组(LVEF40%)32例。结果HFpEF组年龄、体质量指数(BMI)、收缩压,心房颤动、贫血均高于HFrEF组[(76.44±7.28)岁vs (72.47±8.19)岁、(25.11±3.34)kg/m~2 vs (22.95±3.53)kg/m~2、(140.49±20.77)mm Hg vs (131.09±19.96)mm Hg(1mm Hg=0.133kPa)、44.1%vs 25.0%和22.1%vs 6.3%,P0.05,P0.01],HFpEF组主要病因为高血压(85.3%)。HFpEF组肌酐、尿酸、血钾、N末端B型钠尿肽前体、心率、QT间期、QRS间期、室性心律失常、左心室舒张末期内径、左心室收缩末期内径、左心房内径、肺动脉内径均明显低于HFrEF组;血钠、室间隔厚度明显高于HFrEF组(P0.05,P0.01)。HFpEF组使用钙离子通道阻滞剂比例明显高于HFrEF组;血管紧张素转换酶抑制剂类/血管紧张素Ⅱ受体拮抗剂、利尿剂、β受体阻滞剂、洋地黄、调脂药物比例明显低于HFrEF组(P0.05,P0.01)。结论老年女性HFpEF住院患者的年龄较大、BMI较高,高血压、心房颤动、贫血等共病较多见。     

高龄老年高血压患者动态血压特点

目的探讨高龄老年高血压患者动态血压特点。方法选择我院心血管内科及老年医学科住院的高血压患者265例,按年龄分为高龄老年组(年龄≥80岁)94例、老年组(60～79岁)90例和60岁组81例,行动态血压监测,分析其血压节律、3个时段(24h、昼间及夜间)血压均值及血压变异性的特点。结果高龄老年组和老年组杓型血压发生率、24h舒张压、昼间舒张压、昼间平均压、夜间舒张压明显低于60岁组,反杓型血压发生率、24h脉压、昼间脉压、夜间收缩压、夜间脉压明显高于60岁组(P0.05,P0.01);高龄老年组杓型血压发生率及24h、昼间、夜间舒张压明显低于老年组[13.83%vs 26.66%,(66.17±7.39)mm Hg(1mm Hg=0.133kPa)vs (70.39±10.96)mm Hg,(66.90±7.55)mm Hg vs (70.88±11.68)mm Hg,(64.10±8.14)mm Hg vs (68.27±11.86)mm Hg,P0.05,P0.01],24h、夜间脉压明显高于老年组(P0.05,P0.01),昼间收缩压变异明显高于老年组和60岁组,24h收缩压变异高于60岁组,差异有统计学意义(P0.01);老年组24h平均压明显低于60岁组(P0.05)。结论高龄老年高血压患者动态血压表现出血压节律异常、脉压增大、血压变异性升高等特点。     

中国男性老老年高血压患者24h动态血压与脑小血管疾病的关系

目的探讨中国老老年原发性高血压患者24h动态血压与脑小血管疾病(SVD)的关系。方法选择原发性高血压患者106例,进行24h动态血压监测。SVD包括腔隙性脑梗死(LI)和脑白质病变(WML)。根据WML级别分为低级别WML组52例和高级别WML组54例。根据LI数目分为非LI组22例,单发LI组22例,多发LI组62例。根据血压类型分为杓型血压组10例,非杓型血压组96例。结果与低级别WML组比较,高级别WML组夜间收缩压、昼间舒张压、夜间舒张压、24h舒张压明显升高(P0.05,P0.01)。多发LI组夜间收缩压、夜间舒张压较非LI组和单发LI组明显升高[(135.5±13.5)mm Hg vs(125.6±9.0)mm Hg,(129.1±19.6)mm Hg,(67.0±8.7)mm Hg vs(61.8±5.8)mm Hg,(59.9±7.9)mm Hg,1mm Hg=0.133kPa,P0.05],夜间血压下降幅度较非LI组和单发LI组明显减小[(-3.8±6.9)%vs(3.1±6.5)%,(1.7±8.2)%,P0.01]。非杓型血压组多发LI发生率显著高于杓型血压组(62.5%vs 20.0%,P=0.024)。结论中国男性老老年原发性高血压患者异常的血压昼夜节律可能是SVD的一种危险因素。     

双倍剂量厄贝沙坦治疗老年高血压合并慢性肾脏病的疗效观察

目的探讨双倍剂量厄贝沙坦对老年高血压合并慢性肾脏病患者的临床疗效及安全性。方法入选90例高血压合并慢性肾脏病的老年患者随机分为观察组(n=45例)及对照组(n=45)。观察组予双倍剂量厄贝沙坦300mg/d,对照组予常规剂量厄贝沙坦150mg/d治疗,3个月后比较两组血压、尿蛋白定量、肝功能、尿酸、血肌酐及电解质等指标变化。结果治疗3个月后,观察组血压达标率为62.22%,明显高于对照组17.78%(P0.05);24h尿蛋白下降幅度(1.51±0.13)g/24h,明显大于对照组(0.04±0.01)g/24h(P0.05)。两组均未出现转氨酶异常、尿酸增高、血肌酐升高、高钾血症等不良反应。结论双倍剂量厄贝沙坦治疗高血压合并慢性肾脏病老年患者安全有效,能有效控制血压,显著减轻尿蛋白,在降压的同时保护肾脏。     

老年高血压与血尿酸水平关系的探讨

了解老年血压与尿酸关系。方法:随机选择200例老年高血压且近两周未服利尿剂等影响血尿酸水平药物的患者和100例与之年龄、性别相匹配的非高血压受检者,用尿酸-POD法测定其血尿酸水平。结果:高血压组血尿酸水平为346.6±87.7μmol/L,较非高血压组的290.73±95.2μmol/L明显增高,差异显著（P<0.01）。高血压组伴血高尿酸症者41例,占20.5％,非高血压伴高尿酸症者仅6例,占6.0％,二者差异显著（P<0.01）。结论:血尿酸水平与血压水平密切相关,高血压患者应常规监测酸水平,高血尿酸者应注意血压变化。     

阻塞性睡眠呼吸障碍对老年高血压患者血压昼夜节律变化的影响

老年高血压患者103例根据多导睡眠仪监测分为单纯高血压组26例、高血压合并轻度阻塞性睡眠呼吸暂停综合征(OSAS)组29例、高血压合并中度0SAS组30例和高血压合并重度OSAS组18例.行24 h动态血压监测,比较睡眠呼吸参数对血压昼夜节律的影响.结果高血压合并轻度、中度和重度OSAS组昼夜血压曲线呈非杓型的发生率分别为64.29%、76.67%和88.89%,后二组与单纯高血压组(50.00%)比较差异有统计学意义(P＜0.05,＜0.01).认为老年高血压患者血压昼夜节律变化与OSAS严重程度相关,应重视对老年非杓型高血压患者睡眠障碍的监测治疗.     

血清尿酸水平与非勺型原发性高血压的关系

目的研究血清尿酸水平与非勺型原发性高血压的关系。方法共选取150例研究对象纳入研究,其中勺型高血压组,非勺型高血压组,健康对照组各50例。对各组之间的血清尿酸值进行比较,主要观察血清尿酸值与非勺型高血压之间的关系。结果非勺型高血压组与勺型高血压组比较,血清尿酸值(μmol/L)明显升高(413.38±134.38 vs 362.70±77.39;P0.05),勺型高血压组与健康组比较,血清尿酸值明显升高(362.70±77.39 vs 317.80±116.95;P0.05),尿酸值与非勺型高血压进行相关性分析得出相关系数(r=0.33,P0.01)。结论血清尿酸水平与非勺型原发性高血压的存在有相关性。     

吲哒帕安治疗老年人高血压临床疗效观察

目的评价吲哒帕安对老年人高血压的疗效及其对血脂、血糖、血钾和血尿酸的影响。方法６６名老年高血压患者按年龄分３组，分别予吲哒帕安２．５ｍｇ／ｄ治疗，疗程１２周。在治疗前后，分别进行２４ｈ动态血压、血胆固醇、空腹血糖、血钾和血尿酸检查。结果各组降压有效率相近，总有效率８６．４％（Ｐ＜０．０５），其中单纯收缩期高血压患者２３例，降压有效率９１．３％（Ｐ＜０．０５），而对血胆固醇、血糖、血钾和血尿酸的影响无统计学意义（Ｐ＞０．０５）。结论吲哒帕安能安全有效治疗老年人高血压，而对血胆固醇、血糖、血钾、血尿酸无明显影响。     

小剂量利尿剂对胱素C的影响

目的：分析小剂量利尿剂对胱素C的影响。方法：随机选取2014年3月至2016年3月期间在我院重症医学科就诊接受CRRT的AKI患者。试验组为利尿剂组,患者数为40例,对照组为非利尿剂组,患者数为40例,应用连续肾脏替代治疗急性肾损伤,对机械通气及血管活性药应用、平均动脉压(MAP)、血乳酸、血钾、尿量(均取开始CRRT后起初3d的平均值),开始CRRT前1d、治疗后起初3d肾功能[胱素 C(Cys-C)、SCr、尿素氮(BUN)],CRRT时间、住ICU时间和住院时间等指标进行分析,采用SPSS20.0软件进行统计学分析。结果：(1)性别、年龄、入院至入ICU间隔时间、APACHE Ⅱ评分、SOFA评分、基础疾病、AKI的病因和诊断分类等指标在两组之间无统计学差异,符合试验要求。(2)需血管活性药和有创机械通气指标在两组之间有统计学差异(P<0.05);MAP指标在利尿剂组和非利尿剂组之间比为72.53±7.68 VS 88.54±15.87,两组之间有显著统计学差异(P<0.01);乳酸指标在利尿剂组和非利尿剂组之间比为2.21±1.17 VS 2.92±2.74,两组之间有统计学差异(P<0.05);血钾指标在利尿剂组和非利尿剂组之间比为4.13±1.26 VS 4.83±1.25,两组之间有统计学差异(P<0.05);CRRT时间指标在利尿剂组和非利尿剂组之间比为5.12±3.53 VS 7.92±5.95,两组之间有显著统计学差异(P<0.01);住ICU时间指标在利尿剂组和非利尿剂组之间比为15.71±9.56 VS 23.24±17.82,两组之间有显著统计学差异(P<0.01);住院时间指标在利尿剂组和非利尿剂组之间比为20.57±13.34 VS 27.38±19.83,两组之间有显著统计学差异(P<0.01)。(3)开始CRRT治疗前1d、CRRT治疗后1d和2d,Cys-C、BUN、SCr和尿量在利尿剂组和非利尿剂组之间无统计学差异(P>0.05);CRRT治疗后3d,Cys-C指标在利尿剂组和非利尿剂组之间比为1.83±1.05 VS 2.45±1.87,两组之间有统计学差异(P<0.05);BUN指标在利尿剂组和非利尿剂组之间比为12.36±7.87 VS 16.39±7.94,两组之间有统计学差异(P<0.05);SCr指标在利尿剂组和非利尿剂组之间比为180.25±77.79 VS 205.53±134.83,两组之间有统计学差异(P<0.05);尿量指标在利尿剂组和非利尿剂组之间比为679.12±643.54 VS 796.49±1608.35,两组之间有统计学差异(P<0.05)。(4)28d内存活指标在利尿剂组和非利尿剂组之间比为32(80.0%)VS 26(65.0%),两组之间有统计学差异(P<0.05);28d内死亡指标在利尿剂组和非利尿剂组之间比为8(20.0%)VS 14(35.0%),两组之间有统计学差异(P<0.05)。结论：连续肾脏替代治疗急性肾损伤过程中,小剂量利尿剂能降低需血管活性药和有创机械通气的患者数,明显降低MAP,降低血液中乳酸和血钾含量,减少CRRT时间、住ICU时间和住院时间,小剂量利尿剂治疗有助于改善患者的肾功能,治疗后3d,小剂量利尿剂能降低患者血液中Cys-C、BUN和SCr含量,同时减少患者尿量,小剂量利尿剂治疗能提高患者28d内存活数,降低28d内死亡数。     

Diuretic induced hyponatraemia in elderly hypertensive women

Diuretics are recommended as first-line antihypertensive treatment in elderly patients. Although attention is usually paid to prevent hypokalaemia with diuretic therapy, risk of hyponatraemia is often ignored. We performed this study to characterise hypertensive patients at increased risk to develop hyponatraemia. We reviewed charts of hypertensive patients hospitalised in Chaim Sheba Medical Center for hyponatraemia from 1990 to 1997. Patients with other causes of hyponatraemia were excluded. The General Practice Maccabi database was used to estimate age and sex distribution of patients prescribed diuretics for hypertension. We identified 180 hypertensive patients (149 F, 31 M; mean age 76.4 +/- 9.2 years) hospitalised because of hyponatraemia. Across all age groups, odds ratio (OR) to develop hyponatraemia was three times higher for women vs men (OR 3.10, 95% confidence interval (CI): 2.07-4.67). One hundred and sixty-two patients (90%) were older than 65 years. Patients of both sexes older than 65 years were 10 times (and if they were older than 75 years 16 times) more likely to develop hyponatraemia than those younger than 65 years (OR 9.87, 95%, CI: 5.93-16.64). Most patients (74.5%) used a thiazide-based diuretic; only 10% used a low dose (<25 mg/day). In 37% of patients diuretics were used for more than 1 year before hyponatraemia developed. Diuretic-induced hyponatraemia may be insidious and appear even after prolonged diuretics use. Elderly women seem to be at particularly high risk. In this population diuretic use should be associated with close monitoring of sodium and potassium levels.     

Comparison of withdrawing antihypertensive therapy between diuretics and angiotensin converting enzyme inhibitors in essential hypertensives.

One hundred thirteen patients with essential hypertension receiving single or multiple antihypertensive agents were enrolled in the study. All had had mild to severe hypertension before treatment, but their diastolic blood pressure (DBP) at study entry was lower than 90 mm Hg for all measurements. In half of the subjects, non-thiazide diuretics (n = 35) or angiotensin-converting enzyme inhibitors (ACEI, n = 37) were discontinued, and their remaining drugs were maintained throughout the study. The other patients (n = 41) continued all their medications. Forty-one percent of subjects remained normotensive for 12 months after withdrawal of diuretics, and 37% of patients with ACEI discontinuation remained normotensive, although the recurrence of hypertension after withdrawal of ACEI tended to be earlier than its recurrence after withdrawal of diuretics. Serum uric acid and creatinine concentration decreased after diuretic withdrawal, but not after ACEI withdrawal. Diuretic withdrawal resulted in an increase in serum potassium, but ACEI withdrawal induced a decrease in serum potassium. Withdrawal of diuretics or ACEI both significantly reduced plasma renin activity. The present study may be indicative of the ability to withdraw some medications in many patients being treated with multiple antihypertensive agents.     

老年高血压病患者血尿酸水平及其他心血管相关因素

目的 观察老年高血压病患者血尿酸,血脂,胰岛素抵抗指数和内生肌酐清除率等相关因素,探讨血尿酸在老年高血压病患者中的临床意义。方法 老年高血压病组78例（A组）,中青年高血压病组57例（B组）,老年健康对照组41例（C组）。测量体质量指数（BMI）,腰围（WC）,腰臀比（WHR）,检测血尿酸（SUA）,总胆固醇（TC）,三酰甘油（TG）,高密度脂蛋白胆固醇（HDL-C）,低密度脂蛋白胆固醇（LDL-C）,空腹血糖(FBG),空腹胰岛素水平（FIn）,计算胰岛素抵抗指数（HOMA-IR）,血肌酐(Scr),计算内生肌酐清除率（Ccr）。结果 高尿酸血症发生率分别为A组:23%,B组:28%,C组:2%。A组与C组比较,A组BMI、WHR、SUA、TG、TC、SBP、DBP、FIn、HOMA-IR均明显升高,A组Ccr、HDL-C低于C组,具有统计学意义（P<0.05）; A组与B组比较,A组WHR、FIn、HOMA-IR、Ccr、DBP低于B组,具有统计学意义（P<0.05）。结论 高血压病患者高尿酸血症发生率明显升高,血尿酸可作为高血压病患者临床评估的重要指标之一。     

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.     

Clinical update: Spironolactone and altizide as monotherapy in systemic hypertension

A large-scale, open, nonrandomized, multicenter, 90-day study of the safety and efficacy of a thiaride diuretic and aldosterone antagonist combination (Aldactazine^®, 25 mg spironolactone and 15 mg altizide, 1/day) as monotherapy was performed in 946 patients with mild to moderate hypertension (diastolic blood pressure [BP] between 90 and 120 mm Hg). Adverse effects were assessed, and body weight, heart rate, serum potassium, creatinine and uric acid measurements were monitored. On day 45 of the study, BP was normalized (diastolic BP ≤90 mm Hg) in 72% of the patients. The dose was increased to 2 tablets per day in the patients whose BP did not reach normal levels. By the end of the study, BP was controlled in 83% of the patients. No significant changes were noted in body weight, heart rate or laboratory values; however, treatment had to be discontinued in 6 patients because of hypokalemia (n = 4) or elevated serum creatinine levels (n = 2). Serum uric acid levels were increased in 5.5% of patients. The rate of adverse effects, as reported by the patients, was low (5%). Thus, this study demonstrates that diuretics, especially the combination of a thiazide diuretic and aldosterone antagonist, remain a safe, effective and economical therapy for patients with mild to moderate hypertension.     

Felodipine or Hydrochlorothiazide/Triamterene for Treatment of Hypertension in the Elderly: Effects on Blood Pressure, Hypertensive Heart Disease, Metabolic and Hormonal Parameters

Trenkwalder P, Plaschke M, Aulehner R, Lydtin H. Felodipine or Hydrochlorothiazide/Triamterene for Treatment of' Hypertension in the Elderly: Effects on Blood Pressure, Hypertensive Heart Disease, Metabolic and Hormonal Parameters.

The aim of the study was to compare the antihypertensive efficacy of either felodipine or the diuretic combination hydrochlorothiazide/triamterene in a group (n = 65) of elderly (≥70 years) hypertensives (office blood pressure ≥ 60/95 mmHg) with special regard to ambulatory blood pressure monitoring, hypertensive heart disease and metabolic parameters. This was a randomized, double-blind study with a treatment period of 6 months. Reduction of office and 24-hr ambulatory blood pressure was comparable with both treatment regimens; after 6 months, 18 of 29 patients in the felodipine group (62%) and 20 of 27 patients in the diuretic group (74%; p = 0.4) were controlled. While episodes of ischemic type ST-segment depression were significantly reduced in the felodipine group (from 49 to 9 episodes), there was no significant change in the diuretic group (from 24 to 21 episodes). Both regimens decreased left ventricular wall thickness, but the decline in left ventricular muscle mass index was significant only for felodipine. Felodipine did not induce any change in metabolic or hormonal parameters; the diuretic combination significantly increased serum creatinine, uric acid, plasma renin activity, and plasma prorenin. Thus, the antihypertensive efficacy of felodipine and the diuretic combination was comparable in elderly hypertensives; only felodipine, however, improved parameters of hypertensive heart diesease and showed a neutral metabolic and hormonal profile.     

Blood Pressure and Serum Potassium Levels in Hypertensive Patients Receiving or Not Receiving Antihypertensive Treatment

Objective. Serum potassium has a fundamental role in blood pressure (BP) regulation, and there is evidence highlighting the importance of potassium homeostasis in hypertension. The aim of this study was to determine the relationship between serum potassium levels and office BP in untreated essential hypertensives and the effect of antihypertensive medication on serum potassium levels. Setting and Participants. In a retrospective analysis, we collected data for consecutive patients first visiting our Hypertension Clinic from 1999–2004. From this population, we first selected patients who were not taking any antihypertensive medication. Patients who had conditions that could affect potassium metabolism, such as history of arrhythmias treated with digitalis, diabetes mellitus under insulin treatment, and hypo- and hyperthyroidism, were excluded from the study. From the remaining patients, those who had impaired renal function (serum creatinine ≥1.6 mg/dL for men and ≥1.4 mg/dl for women) and patients with secondary forms of hypertension were also excluded. The final population consisted of 817 subjects. Multivariate linear regression analysis was applied, and models were created associating serum potassium with systolic BP, diastolic BP, mean BP, or pulse pressure. The population for the second part of the study consisted of patients first visiting our Hypertension Clinic who were on one antihypertensive agent. This second group included 757 patients, 218 of whom were on β-blockers, 42 on diuretics, 187 on angiotensin-converting enzyme (ACE) inhibitors, 287 on calcium channel blockers (CCBs), and 28 on angiotensin receptor blockers (ARBs). Results. After adjusting for age, gender, and body mass index, significant negative correlations were found between serum potassium levels and systolic BP (R?=??0.093, p?=?0.007), diastolic BP (R?=??0.078, p?=?0.03), mean BP (R?=??0.122, p?=?0.002), and pulse pressure (R?=??0.071, p?=?0.044). The levels of potassium were found to be significantly lower among patients receiving diuretics than those receiving one of the other four drug categories of antihypertensive (p < 0.05 for β-blockers, ACE inhibitors, and CCBs; p < 0.001 for ARBs). In addition, hypokalemia was found to be significantly more prevalent in the group using diuretics than the other groups. Conclusions. The observed reverse relation between serum potassium and BP supports a close pathophysiological connection between serum potassium and essential hypertension. Moreover, diuretic therapy is a significant cause of hypokalemia and requires systematic monitoring.     

Uric Acid as a Marker for Renal Dysfunction in Hypertensive Women on Diuretic and Nondiuretic Therapy

Hyperuricemia is a common finding in hypertensive patients, especially among those who are on diuretic therapy. However, its clinical relevance regarding cardiovascular and chronic kidney disease (CKD) has not clearly been established. The authors assessed whether, in a population of 385 hypertensive women categorized according to diuretic therapy, the stratification in quartiles by uric acid levels would identify a gradient of changes in renal function and in risk factors for cardiovascular disease. The following were evaluated: serum uric acid, glycemia, total and fractional cholesterol, triglycerides, apolipoprotein (Apo) B, Apo A-I, and C-reactive protein. Renal function was assessed by serum creatinine, albuminuria, and estimated glomerular filtration rate (eGFR) by the Modification of Diet in Renal Disease equation, whereas cardiovascular risk was estimated through the Framingham score. A total of 246 women were on diuretic therapy; 139 were taking other antihypertensive medications. There was a reduction in eGFR parallel to the increase in uric acid levels, regardless of diuretic use and without a concomitant increase in albuminuria. In both groups, higher uric acid levels translated into an increase in metabolic syndrome components, in markers of insulin resistance, triglyceride/high-density lipoprotein levels, and Apo B/Apo A-I ratios, as well as in Framingham scores. Hyperuricemia was associated with an increase in inflammatory markers only in patients on diuretic therapy. In a binary logistic regression, hyperuricemia (uric acid >6.0 mg/dL) was independently associated with CKD (eGFR <60 mL/min/1.73 m²) (odds ratio, 2.63; 95% confidence interval, 1.61–4.3; P <.001). In hypertensive women, the presence of hyperuricemia indicated a substantial degree of kidney dysfunction as well as a greater cardiovascular risk profile.