氨氯地平、西拉普利对高血压肾素-血管紧张素、醛固酮和心钠素的影响

Effeets of Amlodipine,Cilazapril on Renin,Angiotension Ⅱ Activity and Aldosterone,Atrial Natriuretic Peptide in Hypertensive Patients

目的观察氨氯地平、西拉普利对高血压患者神经内分泌影响。方法５６例高血压患者按舒张压水平分氨氯地平组（ＤＢＰ９５～１１４ｍｍＨｇ）；氨氯地平加西拉普利组（ＤＢＰ≥１１５ｍｍＨｇ）。在治疗前后分别监测２４ｈ动态血压、血浆肾素（ＰＲＡ）、血管肾张素Ⅱ（ＡｎｇⅡ）、醛固酮（Ａｌｄ）及心钠素（ＡＮＰ）。结果（１）两组服药后，２４ｈＤＢＰ、白昼及夜间ＤＢＰ均明显降低，联合用药组降压幅度更为明显。（２）用药后，氨氯地平组ＡＮＰ升高、Ａｌｄ水平降低；联合用药组ＡｎｇⅡ、Ａｌｄ均明显降低。结论氨氯地平可升高ＡＮＰ，降低Ａｌｄ，西拉普利可增强氨氯地平的降压疗效。

Aim\ To investigate the effects of amlodipine and cilazapril on neuroendocrine system in patients with essential Hypertension(EH).\ Methods\ 56 patients with EH were treated with amlodipine(n=32,5 mg 1/d, at 7AM, DBP≥98 mmHg, ≤114 mmHg) and amlodipine plus cilazapril(n=24,amlodipine 5 mg plus cilazapril 2 5￣5 0 mg 1/d, at 7AM, DBP ≥115 mmHg) for 4 weeks.\ Ambulatory blood pressure(ABP), plasma renin activity(PRA), angiotensionⅡ(AngⅡ), aldosterone(Ald) and atrial natriuretic peptide(ANP) were measured before and after treament.\ Results \ (1)After treatment, 24 hour DBP, daytime DBP and nighttime DBP all decreased in two groups, the decreased extent of BP in amlodipine plus cilazapril group was more prominent than that of Amlodipine alone group.\ (2)ANP, AngⅡ levels were elevated and Ald were reduced in amlodipine group, but Ang Ⅱ, Ald levels were all decreased in amlodipine plus cilazapril group.\ Conclusion\ Increased of ANP and decreased of Ald may play a role in the mechanism of antihypertensive effect of amlodipine. Cilazapril markedly enhances antihypertensive efficacy of amlodipine.