螺内酯与呋塞米对老年难治性高血压患者降压效果及安全性分析

The efficacy and safety of spironolactone and furosemide on elderly patients with refractory hypertension

目的通过分析加用螺内酯及呋塞米等利尿剂对老年难治性高血压患者降压效果及其安全性,探讨老年难治性高血压治疗的有效方案。方法选取老年难治性高血压患者106例并随机分为呋塞米组(51例)和螺内酯组(55例)。在原有治疗方案不变基础上分别给予呋塞米20 mg/d;螺内酯20 mg/d,每4周常规复诊,4周后若血压控制无效者,可分别加量至40 mg,两组患者均连续用药12周,期间不更换其他药物。动态记录患者血压下降情况并计算血压控制有效率,测定治疗前后血糖、低密度脂蛋白、血钾、肌酐、eGFR、尿白蛋白、尿肌酐及U_(ACR)等指标,同时应用超声心动图测定左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD)的变化;记录不良事件。结果 (1)两组降压治疗有效率:口服呋塞米20 mg治疗4周后,降压治疗有效率为51%,加量至40 mg治疗第8、12周观察有效率持续上升;螺内酯20 mg治疗4、8、12周降压有效率持续平稳上升,且均高于同期呋塞米组(P<0.05)。(2)两组降压治疗效果:口服呋塞米20 mg治疗第4周复查血压下降未达到统计学差异(P>0.05),增量至40 mg治疗第8、12周血压下降有统计学意义(P<0.05),而螺内酯20 mg治疗4、8、12周降压效果均有统计学意义(P<0.05),且均高于同期呋塞米组(均P<0.05)。(3)螺内酯组治疗12周后U_(ACR)较治疗前差异有统计学意义(P<0.05),而呋塞米组治疗前后U_(ACR)差异无统计学意义(P>0.05);(4)两组均未出现严重不良反应需退组患者。结论对于老年难治性高血压患者,在"A+C+D"联合用药降压效果欠佳基础上加用呋塞米和螺内酯,可有效降低血压,且螺内酯在降压效果及保护肾功能方面优于呋塞米。

Objective To investigate efficacies and safeties of spironolactone and furosemide on elderly patients with refractory hypertension. Methods A hundred and six elderly patients with refractory hypertension were selected and randomly divided into the furosemide group(51 cases) and the spironolactone group(55 cases). Furosemide or Spironolactone was given on the basis of the original treatment regimen. The patients were revisited every 4 weeks. The dose was adjusted according to the blood pressure control after 4 weeks. Patients in both groups were given continuous medication for 12 weeks without replacement of other drugs. The decline of blood pressure were recorded and the effective rate of the blood pressure control were calculated. The blood sugar, low density lipoprotein, potassium, creatinine, eGFR, urinary albumin, urine creatinine and UACR index were recorded before and after the treatment;at the same time, the changes of left ventricular ejection fraction(LVEF) and left ventricular end-diastolic diameter(LVEDd) were determined via echocardiography. The adverse events were recorded. Results The effective rate of blood pressure control was 51% after 4 weeks of oral furosemide treatment(20 mg), and it was continuously increased after 8 and 12 weeks treatment with increased dosage(40 mg).The effective rate of blood pressure control of spironolactone treatment was continuedly increased after treatment, which were significantly higher than those with furosemide treatment(all P<0.05). No significant improvement in blood pressure control was observed in furosemide treatment at the 4th week;while significant improvements were observed after dose increasement at the 8th and 12th week(P<0.05). Significant improvements in blood pressure control were observed in spironolactone treatment at the 4th, 8th and 12th week;which were all significantly more prominent than those with furosemide treatment(P<0.05). After 12 weeks treatment, there was significant improvement in UACR in spironolactone group(P<0.05), while there was no significant improvement in UACR in furosemide group(P>0.05). No serious adverse reactions occurred in the both groups. Conclusions For elderly patients with refractory hypertension, additional treatment with spironolactone or furosemide can effectively reduce blood pressure. And spironolactone is better than furosemide in the antihypertensive effect and the protection of renal function.