依普利酮与氯沙坦对轻中度原发性高血压患者动脉僵硬度及中心动脉压的影响

The effect of eplerenone and losartan on arterial stiffness and central arterial pressure in patients with mild to moderate essential hypertension

目的探讨依普利酮与氯沙坦对收缩压及舒张压均增高的双期轻中度原发性高血压患者动脉僵硬度及中心动脉压(CAP)的影响。方法随机、双盲、双模拟、阳性药物平行对照设计,将84例轻中度原发性高血压患者[舒张压90～<110mm Hg(1mm Hg=0.133kPa)且收缩压140～<180mm Hg]分为依普利酮组和氯沙坦组,每组各42例,经服用安慰剂2周后进入12周的试验期,分别给予依普利酮50mg或氯沙坦50mg,口服1次/d,复诊1次/2周,4周后如舒张压≥90mm Hg,则改为依普利酮100mg分2次口服或氯沙坦100mg,口服1次/d。安慰剂治疗2周后及12周试验期结束前分别进行肝肾功能、电解质、血糖、血脂、血常规、尿常规、动态血压监测、臂踝脉搏波传导速度(baPWV)和CAP的测定。结果依普利酮组高血压患者完成试验37例,失访5例,氯沙坦组完成试验40例,失访2例;与治疗前相比,依普利酮组及氯沙坦组患者坐位收缩压及舒张压、动态血压参数、baPWV及CAP均明显降低;治疗12周末,两组患者的坐位收缩压及舒张压下降幅度差异无统计学意义[(18.3±8.6)比(21.4±9.4),(14.0±5.3)比(15.1±6.6)mm Hg,均P>0.05];依普利酮组的24h平均收缩压及平均舒张压、昼平均收缩压及平均舒张压、夜平均收缩压及平均舒张压、baPWV、CAP及总的不良事件发生率,与氯沙坦组相比差异无统计学意义(均P>0.05)。结论依普利酮与氯沙坦均能明显降低轻中度收缩压及舒张压均增高的双期原发性高血压患者的动脉僵硬度及中心动脉压。

Objective To investigate the effect of eplerenone and losartan on arterial stiffness and central arterial pressure （CAP） in patients with mild to moderate essential hypertension. Methods A randomized, double-blind, double imitation and positive drug paralledl-controlled trial was designed. Eighty-four patients with mild-to-moder- ate of essential hypertension （DBP 90--〈 110 mm Hg and SBP 140--〈 180 mm Hg} were divided into eplerenone group and losartan group （n=42, respectively）. Every patient in both groups took the placebo for 2 weeks and then was administrated eplerenone or losartan 50 mg every day in the following 12 weeks. All patients visited hos- pital every 2 weeks. If DBP〉90 mm Hg 4 weeks later, the dose was increased （eplerenone 50 mg taken orally twice a day or losartan 100 mg qd）. When the 2 weeks＇ placebo and 12 weeks＂ trial had been completed, the func- tion of liver and kidneys, the blood electrolytes, the blood glucose, the blood lipids, the complete blood cell count, the routine urine test and the ambulant blood pressure monitor （ABPMI, brachial-arm pulse wave velocity （baPWV） and CAP of every patients were detected. Results Five patients in the eplerenone group and 2 patients in the losar- tan group were lost to follow up. By comparison with pre-treatment, the seated SBP and DBP, the ABPM parame- ters, the baPWV and CAP in two groups decreased after 12 weeks＇ treatment respectively, but there was no difference existing in the two groups＇ decreased range of the seated SBP and DBP[（18. 3±8. 6） vs （21.4±9.4）, （14.0± 5.3） vs （15.1±6.6）mm Hg, all P〉0.05）. There was not significant difference in 24 hours＇ average SBP and DBP, the average SBP and DBP at daytime, the average SBP and DBP at nighttime, baPWV, CAP and the total incidence of adverse effect between the two groups （all P〉0. 05）. Conclusion Both eplerenone and losartan can significantly reduce arterial stiffness and central arterial pressure of patients with mild-moderate essential hypertension.