氯沙坦及氯沙坦与双氢克尿噻合剂对原发性高血压患者肾素活性影响的比较

目的比较血管紧张素Ⅱ受体拮抗剂氯沙坦及氯沙坦与双氢克尿噻合剂对原发性高血压患者的降压疗效和肾素活性水平的影响。 方法坐位舒张压95～115mmHg(1mmHg=0.133kPa)的76例原发性高血压患者，经1周药物洗脱期，2周安慰剂期后，随机服用氯沙坦50mg(氯沙坦组，n=37)，每日1次或氯沙坦50mg与双氢克尿噻12.5mg合剂(氯沙坦+双氢克尿噻合剂组，n=39)，每日1次。4周末坐位舒张压≥90mmHg者，剂量分别加倍，继续服用4周。于安慰剂期末及服药8周末测量诊室坐位血压和测定立位血浆肾素活性水平。 结果服药8周末平均坐位舒张压氯沙坦组(n=35)下降10.1±9.1mmHg；氯沙坦+双氢克尿噻合剂组(n=33)下降14.6±7.5mmHg(组间比较P＜0.05)；同时服用末次药24小时后氯沙坦组的平均血浆肾素活性从1.6ng/(ml*h)增加至5.4ng/(ml

The Effect of Losartan and a Combination of Losartan and Hydrochlorothiazide on Plasma Renin Activity in Patients with Hypertension

Objective:To compare the effect of losartan with that of losartan plus hydrochlorothiaxide on plasma renin activity (PRA) in hypertensive patients. 　　Methods:After 1-week washout and 2-week placebo run-in period,patients with seated diastolic blood pressure (SeDBP) 95-115 mmHg (n=76) were administrated with losartan 50 mg once-daily or losartan 50 mg/hydrochlorothiazide 12.5 mg once daily for 4 weeks,followed by double doses once daily for another 4 weeks in those patients with SeDBP≥90 mmHg.Seated blood pressure and heart rate (HR) and PRA were measured after placebo run-in and at the end of the eighth week. 　　Result:SeDBP decreased 10.1±9.1 mmHg in losartan group (n=35) and 14.6±7.5 mmHg in a combination group of losartan/hydrochlorothiazide (n=33).PRA increased from 1.6 ng/(ml*h) to 5.4 ng/(ml*h) in losartan group and from 1.2 ng/(ml*h) to 6.6 ng/(ml*h) in the combination group.The decrease in SeDBP is related to change in PRA (r=0.44,p＜0.01) in the combination group. 　　Conclusion:Long-term blockade of the feedback Ang Ⅱ in hypertensive patients produces modest increases of PRA that do not appear to affect the antihypertensive response to the antagonist.The decrease in SeDBP is related to change in PRA (r=0.44,p＜0.01) in the combination group.But there are no clear relations between the changes of PRA and antihypertensive efficacy in losartan group.