Low-renin status in therapy-resistant hypertension: a clue to efficient treatment
Low-renin status in therapy-resistant hypertension: a clue to efficient treatment
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难治性高血压中的低肾素状态：有效治疗的线索
DOI：
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发表时间：
2004
影响因子：
4.9
通讯作者：
Nils P Lilledahl
中科院分区：
文献类型：
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作者：
I. Eide;P. Torjesen;A. Drolsum;A. Babovic;Nils P Lilledahl
目的治疗抵抗是临床高血压病长期存在的问题。我们的目标是估计：（1）低肾素状态在治疗抵抗中的作用;（2）这种状态是否能为更成功的治疗提供线索;（3）肾上腺皮质腺瘤和原发性醛固酮增多症的作用。设置患者从一般和内科实践后，书面邀请，并连续纳入。参与者在门诊接受检查和随访。设计和干预根据肾素状态对患者进行分组。在一项前瞻性、随机、安慰剂对照、双盲、交叉研究中，低肾素患者接受醛固酮抑制剂治疗。主要结果测量治疗抵抗中低肾素状态的患病率。血压和激素对特定治疗的反应。肾上腺皮质腺瘤和原发性醛固酮增多症的数量。结果在90例难治性高血压患者中，67%的患者血浆肾素活性（PRA）低于0.5nmol/l/h。在60名低肾素患者中，38名患者接受了阿米洛利和氢氯噻嗪的固定组合。与安慰剂相比，三周的治疗使血压降低了31/15 mmHg（P <0.0001）。积极治疗期间血清醛固酮和血浆肾素活性显著升高。通过随后的6-12个月的开放治疗，7例（18%）显示逃逸现象的患者通过额外的阿米洛利有效治疗了高血压。在60名低肾素患者中，8名患有肾上腺腺瘤。结论2/3难治性高血压患者存在低肾素状态，醛固酮抑制剂可有效治疗。有逃避现象的患者（18%）可通过增加醛固酮抑制剂有效治疗。低血压患者肾上腺皮质腺瘤和原发性醛固酮增多症的患病率较高。
Objective Therapy resistance is an enduring problem in clinical hypertension. Our aims were to estimate: (1) the contribution of a low-renin status in therapy resistance; (2) whether such status could give a clue to more successful treatment; and (3) the contribution by adrenal cortical adenomas and by primary aldosteronism. Setting Patients were referred from general and internal medicine practices following written invitations and included consecutively. Participants were examined and followed-up on an outpatient basis. Design and interventions Patients were divided according to renin status. Low-renin patients were treated with an aldosterone inhibitor in a prospective, randomized, placebo-controlled, double-blind, cross-over study. Main outcome measures Prevalence of low-renin status in therapy resistance. Blood pressure and hormonal responses to specific treatment. Numbers of adrenocortical adenomas and primary aldosteronism. Results In 90 treatment-resistant hypertensive, 67% had plasma renin activity (PRA) below 0.5 nmol/l per hour. Of the 60 low-renin patients, 38 were studied on a fixed combination of amiloride and hydrochlorothiazide. Three weeks’ treatment reduced blood pressure by 31/15 mmHg compared to placebo (P ⩽ 0.0001). Serum aldosterone and plasma renin activity increased substantially during active treatment. Through the subsequent 6–12 months of open treatment, seven patients (18%) showing an escape phenomenon had their high blood pressure effectively treated by extra amiloride. Of the 60 low-renin patients, eight had adrenal adenoma. Conclusion A low-renin status characterized two-thirds of patients with treatment-resistant hypertension, who could be treated efficiently by aldosterone inhibition. Patients with an escape phenomenon (18%) could effectively be treated by increasing the aldosterone inhibitor. Low-renin hypertensives had high prevalence of adrenocortical adenomas and primary aldosteronism.
原发性醛固酮增多症的筛查：血浆醛固酮/肾素比率增加的影响。
影响因子：
9.3
作者：
Schwartz,GaryL;Chapman,ArleneB;Boerwinkle,Eric;Kisabeth,RobertM;Turner,StephenT
通讯作者：
Turner,StephenT
原发性醛固酮增多症的诊断和两种主要亚型的分离。
影响因子：
--
作者：
Weinberger,MH;Fineberg,NS
通讯作者：
Fineberg,NS
DOI：
10.1073/pnas.96.4.1727
发表时间：
1999-02-16
影响因子：
11.1
作者：
McDonald, FJ;Yang, BL;Williamson, RA
通讯作者：
Williamson, RA