原发性高血压患者醛固酮逃逸现象与左心室肥厚的关系

目的探讨原发性高血压(EH)患者使用血管紧张素转换酶抑制剂(ACEI)依那普利后并发的醛固酮逃逸及与左心室肥厚(LVH)的关系,并观察ACEI联合使用螺内酯后对醛固酮逃逸和LVH的效果。方法65例EH患者分为左心室肥厚组(LVH组)和非左心室肥厚组(NLVH组),使用依那普利。分别于治疗前及治疗后1、3、6个月采血检测血管紧张素Ⅱ(AngⅡ)、醛固酮(Ald)浓度,并用超声心动图测定左心室重量指数(LVMI)。根据3个月时的Ald浓度,判断有无醛固酮逃逸,对有醛固酮逃逸者,联合用螺内酯3个月,观察效果。结果依那普利治疗后1个月,AngⅡ、Ald与治疗前相比均下降,但3个月时,AngⅡ有所升高,Ald明显增高,65例中有28例并发醛固酮逃逸。治疗前LVH组的Ald明显高于NLVH组,LVMI与Ald呈明显的正相关;LVH组治疗3个月,无醛固酮逃逸者的LVMI与治疗前比较有显著下降,有醛固酮逃逸者LVMI变化不显著。结论EH患者长期使用ACEI后会出现醛固酮逃逸现象,Ald与EH合并的LVH有明显的相关性,ACEI能逆转EH所合并的LVH,但醛固酮逃逸能阻碍ACEI对LVH的逆转作用,ACEI联合使用螺内酯可能会改善醛固酮逃逸。

The relationship between aldosterone escape and left ventricular hypertrophy in essential hypertensive patients

Objective To investigate aldosterone (Ald) escape during enalapril therapy in essential hypertensive(EH) patients and its relationship with left ventricular hypertrophy (LVH),and observe the effects of Ald antagonist-spironolactone combined with enalapril,on aldosterone escape and left ventricular hypertrophy.Methods Sixty-five EH patients were divided into LVH group and non-left ventricular hypertrophy (NLVH) group,and treated with enalapril.Plasma angiotensin Ⅱ (AngⅡ) and Ald concentrations were measured by commercial radioimmunoassay;left ventricular mass indices (LVMI) were calculated by echocardiography before and in 1,3,6 months after the treatment respectively.Aldosterone escape was estimated by the plasma Ald levels after a three-month treatment,spironolactone was given to those patients with aldosterone escape,and the effects were observed.Results After one-month enalapril treatment,both the plasma AngⅡ and Ald concentrations of the patients decreased,compared with those before treatment.But after a three-month treatment,the plasma AngⅡ levels increased slightly,the plasma Ald levels increased significantly.Aldosterone escape was observed in 28 of 65 patients after a 3-month enalapril treatment.Before treatment the plasma Ald level of LVH group was higher than that of NLVH group,there was a positive correlation between the plasma Ald level and LVMI.After a 3-month treatment,in the LVH group,LVMI did not change in patients with aldosterone escape but decreased significantly in patients without aldosterone escape.After treated with spironolactone for 3 months, the plasma AngⅡ and Ald concentrations of 28 patients with aldosterone escape decreased,but no statistical significance and the LVMI of 16 patients with aldosterone escape in LVH group decreased,but no statistical significance either.Conclusion Aldosterone escape may occur during continuous (>3 months) angiotensin-converting enzyme inhibitor (ACEI) therapy in some EH patients. There is relationship between the plasma Ald level and LVH in EH patients. Aldosterone escape may reverse the beneficial effects of ACEI on LVH.Aldosterone antagonist-spironolactone combined with ACEI may be useful to aldosterone escape in EH patients.