不同血管紧张素转换酶基因型高血压患者治疗依从性差异对终点事件的影响

目的探讨长期降压治疗的依从性差异对不同血管紧张素转换酶(ACE)基因型高血压患者临床终点事件的影响。方法于2002年6月—2003年5月选择轻、中度高血压患者853例,入选患者经安慰剂洗脱2周和氢氯噻嗪(HCTZ)导入6周后随机给予HCTZ 12.5mg/d或HCTZ 12.5mg/d+螺内酯20mg/d或HCTZ 12.5mg/d+卡托普利25mg2次/d。治疗期间每月随访1次,监测血压,记录终点事件,每年进行生化指标检测,随访6年。根据患者的治疗依从性分为依从组和非依从组,比较不同依从组各基因型患者临床终点事件发生率。结果第6年时依从组发生临床终点事件20例(致死性2例,非致死性18例),低于非依从组61例(致死性15例,非致死性46例),差异有统计学意义(P0.01)。依从组各基因型间累积发生事件率差别无统计学意义;而非依从组DD基因型的累积发生事件率最高(25.7%),ID型为15.4%,Ⅱ型为12.8%,且各基因型间发生率差异有统计学意义(P0.05)。结论 ACE基因DD基因型是治疗依从性不良高血压患者发生临床心脑事件的危险因素,而良好的治疗依从性可减轻或消除DD基因型对心脑事件的不利影响。

Effect of Medication Compliance on the Outcomes in Hypertensive Patients with Different Genotypes of Angiotensin Converting Enzyme Gene

Objective To explore effect of medication compliance on the outcomes in hypertensive patients with different genotypes of angiotensin converting enzyme （ACE） gene. Methods A total of 853 patients with mild to moderate hypertension were randomized to receive one of therapies hydroehlorothiazide （HCTZ）12.Stag q.d or HCTZ 12.Stag plus spironolactone 20rag q. d or HCTZ 12.Stag q.d plus captopril 25rag bid] after 2-week placebo washout period and 6-week loading period for HCTZ. Blood pressure and clinical outcomes were recorded monthly. Blood biochemical parameters were determined once a year. All patients had been followed up for 6 years. According to compliance with the therapy, the patients were divided into compliance group or non-compliance group. The incidences of cardio-cerebral vascular events were compared between different groups. Results By the end of 6-years follow-up period, frequencies of cardio-cerebral vascular events was significantly lower in compliance group （2 fatal, 18 non-fatal） than that in non-compliance group （15 fatal, 46 non-fatal, P〈0.01）. The incidence of cardio-cerebral vascular events among patients with different genotypes of ACE gene were no difference in compliance group （P〉0.05）, but it was significantly higher in patients with DD genotype than that in patients with II and ID genotypes in non-compliance group （P〈0.05）. Conclusion This study indicates that DD genotype of ACE gene is a risk factor of increasing incidence of cardio-cerebral vascular events among non-compliance hypertensive patients, hut the risk can be reduced or eliminated among compliance patients.