血管紧张素Ⅱ受体拮抗剂干预高血压患者尿酸代谢的对比研究

目的观察血管紧张素Ⅱ受体拮抗剂（ARB）氯沙坦与伊贝沙坦治疗对伴高尿酸血症的原发性高血压患者血清尿酸水平的影响并评价其降压疗效。方法采用多中心、随机、双盲、平行对照设计。伴高尿酸血症（血清尿酸浓度男性≥390μmo]／L,女性≥310μmo]／L）的1～2级原发性高血压患者,经2周安慰剂洗脱期后,随机分入氯沙坦组（50mg／d）或伊贝沙坦组（150mg／d）,治疗4周,如血压得到控制收缩压〈140mmHg（1mmHg=0．133kPa）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],将上述药物剂量加倍,继续治疗4周,观察血清尿酸浓度及血压的变化。结果随机入选351例患者,325例完成试验,氯沙坦组162例,伊贝沙坦组163例。与治疗前比较,氯沙坦组治疗4周末、8周末血清尿酸浓度明显降低（P〈0．0001）,伊贝沙坦组则无明显降低（P〉0．05）;两组之间比较,治疗4周、8周血清尿酸浓度氯沙坦组明显低于伊贝沙坦组（P〈0．0001）。与治疗前比较,两组治疗4周、8周末收缩压和舒张压均有明显下降（P〈0．0001）;两组之间比较,治疗4周、8周末收缩压和舒张压差异无统计学意义（P〉0．05）。结论氯沙坦治疗能显著降低伴高尿酸血症的原发性高血压患者的血清尿酸水平,伊贝沙坦无明显降低血清尿酸作用;两种ARB均能有效控制血压。因此,氯沙坦是治疗伴高尿酸血症的轻中度高血压患者的理想选择。

The effects of angiotensin II receptor blockers in hypertensive patients complicating hyperuricaemia

OBJECTIVE: To study the effects of angiotensin II receptor blockers (ARB), losartan and irbesartan, on blood pressure and serum uric acid (SUA) level in mild to moderate essential hypertensive patients complicating hyperuricaemia. METHODS: A total of 351 eligible patients were recruited in this multi-center, randomized, double-blind parallel clinical trial. After 1 week screening and a 2 week single-blinded placebo wash-out period, patients were randomly assigned to receive losartan 50 mg (n=76) or irbesartan 150 mg (n=175) once daily for 4 weeks, followed by a double-dose for another 4 weeks in patients whose seated DBP were >or=90 mm Hg or SBP>or=140 mm Hg at the end of 4 weeks. The SUA concentration and blood pressure were measured at baseline, 4 and 8 weeks post therapy. RESULTS: Three hundred and twenty-five patients completed the study (162 in the losartan group and 163 in the irbesartan group). Both groups were well matched for baseline clinical characteristics and demographics. SUA was significant reduced in losartan group (430.93 micromol/L vs 372.35 micromol/L, P<0.0001), but not in Irbesartan group (430.46 micromol/L vs 420.67 micromol/L, P>0.05) 8 weeks post therapy compared to baseline level. Blood pressure was significantly and equally reduced in both groups after 8 weeks treatment compared to baseline level (P<0.0001). CONCLUSION: Losartan is an optimum choice of medication for patients with mild-to-moderate hypertension complicating hyperuricemia.