Aldosterone breakthrough during angiotensin II receptor blockade in hypertensive patients with diabetes mellitus.
Aldosterone breakthrough during angiotensin II receptor blockade in hypertensive patients with diabetes mellitus.
复制标题
高血压合并糖尿病患者血管紧张素 II 受体阻断期间醛固酮突破。
DOI：
10.1016/j.amjhyper.2007.09.001
复制
发表时间：
2007
影响因子：
3.2
通讯作者：
M. Yamagishi
中科院分区：
文献类型：
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作者：
T. Yoneda;Y. Takeda;Mikiya Usukura;N. Oda;H. Takata;Yasuhiro Yamamoto;S. Karashima;M. Yamagishi
背景：在心血管和肾脏疾病中，醛固酮是一种独立于肾素-血管紧张素系统的重要致病因子。血管紧张素转换酶(ACE)抑制剂治疗中的醛固酮突破被报道用于高血压、糖尿病和慢性肾脏疾病。目前尚不清楚血管紧张素II受体阻滞剂(ARB)是否能引起高血压和糖尿病患者的醛固酮突破，也不清楚这些患者的肾脏损害是否与醛固酮突破有关。用坎地沙坦(8 mg/d，n=47)或valsartan(80 mg/d，n=48)治疗15个月。观察治疗前、治疗后3、6、12、15个月的血压(BP)、尿白蛋白排泄量(UAE)、生化指标、血浆醛固酮浓度(PAC)、血浆肾素活性(PRA)的变化。9例在ARB治疗后出现醛固酮突破的患者被给予螺内酯(25 mg/d)治疗3个月，并在治疗后测量血压、UAE和生化指标。结果虽然两组患者的总体PAC均显著降低(P<；0.05)，但95例患者(22%；醛固酮突破)中有21例(坎地沙坦，11例；valsartan，10例)PAC最终升高。在治疗期间，两组的血压、PRA和生物医学标记物没有差异。尽管有或没有醛固酮突破的患者在6个月时UAE显著降低，但在治疗15个月时，醛固酮突破的患者的UAE再次增加。安体舒通治疗显著降低了这些患者的UAE。结论坎地沙坦或valsartan治疗的高血压合并糖尿病患者的醛固酮突破是相同的。醛固酮阻断治疗可有效预防醛固酮突破的高血压患者的肾损伤。Am J Hyperten 2007；20：1329-1333；2007美国高血压杂志有限公司。
BackgroundAldosterone is an important pathogenetic factor, independent of the renin-angiotensin system in cardiovascular and renal disease. Aldosterone breakthrough during angiotensin-converting enzyme (ACE) inhibitor therapy was reported in hypertension, diabetes mellitus, and chronic renal disease. It is unclear whether the angiotensin II receptor blocker (ARB) causes aldosterone breakthrough in patients with hypertension and diabetes mellitus, and whether aldosterone breakthrough contributes to renal injury in these patients.MethodsWe prospectively studied 95 hypertensive patients with diabetes mellitus. Patients were treated with candesartan (8 mg/day,n= 47) or valsartan (80 mg/day,n= 48) for 15 months. Blood pressure (BP), urinary albumin excretion (UAE), biochemical markers, plasma aldosterone concentration (PAC), and plasma renin activity (PRA) were measured before and at 3, 6, 12, and 15 months of treatment. Nine patients who exhibited aldosterone breakthrough after treatment with ARB were placed on spironolactone (25 mg/day) for 3 months, and BP, UAE, and biochemical markers were measured after treatment.ResultsAlthough the overall PAC was significantly decreased (P< .05) in each group, it eventually increased in 21 (candesartan, 11 patients; valsartan, 10 patients) of 95 patients (22%; aldosterone breakthrough). Blood pressure, PRA, and biomedical markers did not differ between the two groups during treatment. Although UAE was significantly decreased in patients with or without aldosterone breakthrough at 6 months, it was increased again at 15 months of treatment in patients with aldosterone breakthrough. Treatment with spironolactone markedly reduced UAE in these patients.ConclusionsAldosterone breakthrough was seen to be equal in hypertensive patients with diabetes mellitus treated with candesartan or valsartan. Aldosterone blockade therapy may be effective in preventing renal injury in hypertensive patients with aldosterone breakthrough. Am J Hypertens 2007;20: 1329–1333 © 2007 American Journal of Hypertension, Ltd.
DOI：
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发表时间：
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期刊：
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影响因子：
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通讯作者：
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影响因子：
8.3
作者：
Rocha, R;Chander, PN;Stier, CT
通讯作者：
Stier, CT