吲哒帕胺对高血压高危患者血清肌酐、尿酸、血钾及左室肥厚的长期影响

long-term effects of indapamide on serum creatinine, uric acid, potassium and left ventricular hypertrophy in hypertensive patients with high risk

目的 观察吲哒帕胺 (寿比山 )在高血压高危患者中长期应用时SCr、UA、血钾的变化 ,以及合用血管紧张素转换酶抑制剂 (ACEI)能否减轻这些变化。方法 吲哒帕胺组 (Ⅰ组 ) 182例 ,给予吲哒帕胺 2 .5mg/d口服 ,如 2～ 4周后未达到目标血压 (<14 0 / 90mmHg)则加用ACEI苯那普利 (10mg/d)或卡托普利 (2 5～ 75mg/d)。对照组 (C组 )2 10例 ,给予钙拮抗剂 (硝苯地平 30mg/d或非洛地平 5mg/d)或 /和ACEI(苯那普利 10mg/d或卡托普利 2 5～ 75mg/d) ,治疗前后测定SCr、UA、血钾、血脂和血糖并做心超测定左室重量指数。结果 Ⅰ组SCr、UA明显升高 ;Ⅰ组有 7例SCr>2 5 0 μmol/L(而C组为 3例 ,3.8%vs 1.4 % ,P <0 0 5 ) ;7例因UA明显升高而诱发痛风 ;血钾明显降低 (P <0 0 0 1) ,低血钾发生率 14 .8% (C组仅 1.4 % ,P <0 0 0 1)。在Ⅰ组中 ,吲哒帕胺与ACEI合用者与单用吲哒帕胺者相比 ,SCr和UA升高的幅度及血钾降低的幅度明显降低 (P <0 0 1) ,低血钾的发生率亦明显减少 (5 .8%vs 2 5 .3% ,P<0 0 1)。Ⅰ组和C组伴LVH者的LVMI分别减轻 10 8%和 11.5 %。Ⅰ组单用吲哒帕胺的有效降压 (BP <14 0 / 90mmHg)率为 4 9.2 % ,加用ACEI后提高到 85 .3%。结论 吲哒帕胺降压作用肯定 ,长期服用能减轻高血压左室肥厚 ,对?

Objective To study the changes in serum creatinine, uric acid and potassium after long term indapamide treatment alone and combination with ACEI. Methods Indapamide was given 2.5 mg/day in group Ⅰ ( n =182) and an ACEI (either benazipril or captopril) was added when the target BP(<140/90 mmHg) was not achieved. Two hundren and ten hypertensive patients who were given a kind of CCB(either nifedipine 30 mg/d or felodipine 5 mg/d) or/and ACEI (benaziprile or captopril ) served as control ( group C). Serum creatinine(Cr), uric acid(UA) and potassium were determined before and after treatment. UCG was conducted to determine LVMI. Patients were followed up for 31.2 months. Results Scr and Sua were obviously increased in group Ⅰ with gout attack in 7 pationts. The frequency of hypokalemia in group Ⅰ was signifiacntly higher than that in group C(14.8% vs 1.4%). The elevated levels of Cr and UA were attenuated by combination of Indapamide and ACEI with less frequency of hypokalemia.\ The effective response rate in group Ⅰ was elexated when ACEI was administered(49.2% to 85.3%). Conclusion Indapamide is effective in treatment of hypertensives, however, periodical examinations of Cr, UA and potassium are necessary. Combination of Indapamide and ACEI not only enhances the antihypertensive effect but also significantly alleviated the adverse effects of indapamide.