降尿酸治疗对高血压并高尿酸血症血压的影响

The Effect of Hypouricemic Therapy on the Blood Pressure of the Patients with Hypertension complicated with Hyperuricemia

目的探讨降尿酸治疗是否会对高血压合并高尿酸血症患者的血压产生影响。方法选择2007～2010年新诊断且从未治疗的50例轻度高血压合并高尿酸血症患者,经2周安慰剂期观察后,随机、双盲分为别嘌呤组25例(服别嘌醇100mg,3次/天)和对照组25例(服模拟药片1片,3次/天),分别服用4周。于服安慰剂期末及用药4周末测诊室血压、24小时动态血压(ABPM)、血尿酸、血管紧张素Ⅱ(AngⅡ)、血尿常规及肝肾功各1次并记录症状、体征。结果 4周末别嘌呤组坐位收缩压(SiSBP)/坐位舒张压(SiDBP)较用药前下降(13.2±10.7/8.4±9.1)mmHg(P<0.05),对照组下降(5.8±5.6/4.6±6.0)mmHg(P>0.05)。用药4周末血压下降值组间比较差异有显著性(P<0.05)。别嘌呤组4周末24小时平均SBP、DBP下降(8.5±9.1/5.2±8.6)mmHg(P<0.05)。对照组下降(3.0±5.1/1.72±5.7)mmHg(P>0.05),用药4周末两组间24小时平均SBP、DBP差值及血压负荷值(BPL)差异均有显著性(P<0.05)。别嘌呤组用药4周末血尿酸及AngⅡ活性均明显降低,两组间比较差异有显著性(P<0.05)。结论本研究结果显示,别嘌呤在治疗高尿酸血症的同时能够有效降低血压,其机制可能与抑制肾素～血管紧张素系统(RAS)有关。降尿酸治疗可能是高血压治疗的一个新方向。

Objective To discuss the effect of hypouricemic therapy on the blood pressure of the patients with hypertension complicated with hyperuricemia.Methods 50 cases newly diagnosed to be with mild hypertension complicated with hyperuricemia but never treated were randomly divided into 2 groups after taking placebos for 2weeks： allopurinol group and control group,25 cases in each group;the patients in allopurinol group took allopurinol 100mg 3 times a day for 4 weeks while the patients in control group took simulated tablet,1 tablet once and 3 times a day for 4 weeks;at the end the 4 weeks,the clinical blood pressure,24-hour ambulatory blood pressure（ABPM）,serum uric acid,Ang II,blood and urine routine,hepatic and renal function were detected,ad the symptoms and physical signs were recorded.Results At the end of the 4 weeks,the SiSBP/SiDBP of the patients in allopurinol group dropped down（13.2±10.7/8.4±9.1）mm Hg（P0.05） while those of the patients in control group dropped down（5.8±5.6/4.6±6.0）mmHg（P0.05）,the difference of blood pressure decrease was significant between the 2 groups（P0.05）;the 24-hour average SBP and DBP decrease in allopurinol group was（8.5±9.1/5.2±8.6）mmHg（P0.05） while that in control group was（3.0±5.1/1.72±5.7）mmHg（P0.05）,the difference between the 2 groups was obvious as well as the difference of BPL（P0.05）;the serum uric acid level and the activation of Ang II in allopurinol group decreased obviously more than those in control group（P0.05）.Conclusions Allopurinol can effectively decrease blood pressure when applied in the treatment of hyperuricemia,the mechanism might be related to its inhabitation of RAS;hypouricemic therapy may be a new way for the treatment of hypertension.