别嘌醇治疗中青年高血压病合并高尿酸血症

Effect of Allopurinol on Lowering Blood Pressure in Young and Middle-age with Newly Diagnosed Essential Hypertension and Hyperuricemia

【目的】探讨别嘌醇对中青年原发性高血压合并高尿酸血症患者的治疗效果。【方法】入选60例初发的中青年原发性1级高血压合并高尿酸血症患者,随机分为别嘌醇治疗组(低嘌呤饮食控制+别嘌醇200 mg,3次/d)和对照组(低嘌呤饮食控制)各30例,4周后观察诊室血压、动态血压、血尿酸、肝功能、肾功能及血浆卧位肾素、血管紧张素Ⅱ(AngⅡ)等变化。【结果】两组患者基线资料无明显差别,治疗4周结束时,两组在降低诊室平均收缩压[(7.9±2.9)mmHg vs.(2.4±1.5)mmHg,P<0.05]、诊室平均舒张压[(5.7±2.0)mmHg vs.(2.1±1.3)mmHg,P<0.05]、24 h平均收缩压[(6.8±2.7)mmHg vs.(0.7±1.2)mmHg,P<0.05]、24 h平均舒张压[(4.8±1.3)mmHg vs.(0.5±0.9)mmHg,P<0.05]方面均有统计学意义。别嘌醇组血压降至正常的比例更大(62.1%vs.6.7%,P<0.01)。两组在降低尿酸方面有显著差异[(85.1±18.1)μmol/L vs.(17.1±9.8)μmol/L,P<0.05]。别嘌醇组血尿酸降至正常的比例更大(86.2%vs.16.7%,P<0.05)。别嘌醇组卧位肾素、AngⅡ活性明显下降(P<0.05)。治疗结束时两组肝功能、肾功能、血糖、血脂等均无明显改变,未发现明显严重副作用。【结论】高尿酸血症在中青年高血压病的发生中起着重要的致病作用,别嘌醇在有效降低血尿酸的同时能够降低血压,安全性良好。其机制可能与抑制RAS活性有关。别嘌醇可望成为轻度高血压合并高尿酸血症患者一种新的高血压治疗药物,其在临床的推广需要更大样本量的临床试验。

[ Objective] To explore therapeutic effect of Allopurinol on antihypertension in young and middle-age with hypertension and hyperuricemia. [Methods] Randomized trial involving 60 young and middle-age with stage 1 essential hypertension and hyperuricemia, who were newly diagnosed while anti-hypertensive agent naive. Thirty cases were in allopurinol group, given the drug 200 mg three times daily in addition to a low-purine diet for 4 weeks; another 30 cases were in control group, in a low- purine diet for 4 weeks. Clinic blood pressure, ambulatory blood pressure, uric acid, hepatic and renal function, serum rennin, and angiotensinlI （AngⅡ） were measured at baseline and the end of the study. [Results] Four weeks later, there were significant differences between two groups in decrease of clinic SBP [（7.9 ± 2.9）mmHg vs. （2.4 ± 1.5）mmHg, P 〈 0.05], clinic DBP [（5.7 ± 2.0）mmHg vs. （2.1 ± 1.3）mmHg, P 〈 0.053, mean ambulatory SBP [（6.8 ± 2.7）mmHg vs. （0.7 ± 1.2） mmHg, P 〈 0.05], mean ambulatory DBP [（4.8 ± 1.3）mmHg vs. （0.5 ± 0.9）mmHg, P 〈 0.05]. More patients achieved target clinic and ambulatory BP in allopurinol group （62.1% vs. 6.7% in control group, P 〈 0.01）. The decrease of serum uric acid in the allopurinol group was （85.1 ± 18.1）umol/L [vs. （17.1± 9.8）umol/L in control group, P 〈 0.05]. More patients achieved normal serum uric acid in allopurinol group （86.2% vs. 16.7% in control group, P 〈 0.05）. Serum rennin and AngIl decreased significantly after treating with allopurinal （P 〈 0.05 vs. control group）. There was no severe adverse effect in 4 weeks treatment. Hepatic and renal function, fasting blood glucose, and lipid were not significantly different between the two groups. [Conclusion] Treating young and middle-age with hypertension and hyperuricemia with allopurinol resulted in reduction of BP. The result suggested a new potential therapeutic approach for hypertension with hyperuricemia.