小剂量螺内酯治疗80岁以上高龄老人顽固性高血压的疗效分析

Curative Effect Analysis of Spironolactone on People Over 80 Years Old with Resistant Hypertension

目的:通过对高龄老人顽固性高血压患者加用小剂量螺内酯治疗,观察小剂量螺内酯对高龄老人顽固性高血压治疗的安全性及有效性。方法:选取2012年1月-2013年12月于本院干部病房住院的符合顽固性高血压诊断标准的80岁以上高龄老人42例,所有患者均不能耐受特殊检查及有创非药物治疗,在包括利尿剂在内的三联降压药治疗基础上,给予小剂量螺内酯20 mg/d,口服或鼻饲,共治疗1个月,观察收缩压及舒张压下降的情况。期间如果出现血压明显下降先调整其他降压药的应用,如果其他药物的剂量不能再减时,调整螺内酯的剂量;若血压无明显下降则不调整其他药物的种类及剂量。监测加用小剂量螺内酯治疗前后患者收缩压、舒张压、血清钾及血清肌酐变化情况;观察有无干咳、男性乳腺发育等不良反应发生。结果:治疗后所有患者收缩压、舒张压均有下降,与治疗前比较差异均有统计学意义(P<0.05);有效率为100%;同时血清肌酐、血清钾无明显改变,与治疗前比较差异均无统计学意义(P>0.05)。所有患者无干咳及男性乳房发育出现。结论:小剂量螺内酯对80岁以上高龄老人顽固性高血压治疗有效且安全。

Objective：To add the low dose of spironolactone in the elderly patients with refractory hypertension, and observe the safety and efficacy of the small dose spironolactone in the treatment of elderly patients with refractory hypertension.Method：42 cases of 80 years old refractory hypertension in January 2012 to December 2013 in our hospital were selected,and they were conformed to the diagnosis standard of resistant hypertension. All patients were unable to tolerate the special examination and a non drug therapy,with a small dose of spironolactone 20 mg/d,oral or nasal feeding based on triple antihypertensive medication included diuretics,treatment for 1 months,and systolic and diastolic blood pressure were observed. If there was blood pressure decreased significantly during the treatment,could adjust other antihypertensive drugs,if the dose of other drugs could not reduce,adjusted the dosage of spironolactone. If the blood pressure was not decreased,adjusted the type and dosage of other drugs anymore.The changes of systolic pressure diastolic pressure,serum potassium and serum creatinine before and after treatment of combined with small dose of spironolactone were monitored;the adverse reaction such as dry cough,male breast development were observed.Result：Compared with before treatment,all patients’systolic blood pressure,diastolic blood pressure were decreased after treatment,the differences were statistically significant（P〈0.05）;the effective rate was 100%;while had no obvious effect on the serum creatinine,serum potassium,the differences were no statistically significant（P〉0.05）. All patients had no cough and male breast development.Conclusion：A small dose of spironolactone is effective and safe for the elderly aged above 80 years old with intractable hypertension treatment.