Greater reductions in plasma aldosterone with aliskiren in hypertensive patients with higher soluble (Pro)renin receptor level
Greater reductions in plasma aldosterone with aliskiren in hypertensive patients with higher soluble (Pro)renin receptor level
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DOI：
10.1038/s41440-018-0037-1
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发表时间：
2018-06-01
影响因子：
5.4
通讯作者：
Ichihara, Atsuhiro
中科院分区：
文献类型：
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作者：
Bokuda, Kanako;Morimoto, Satoshi;Ichihara, Atsuhiro
肾素受体（原）在组织肾素-血管紧张素-醛固酮系统的调节中是重要的。单用阿利吉仑而不使用其他肾素-血管紧张素-醛固酮系统抑制剂的益处和安全性尚不清楚。可溶性形式的（原）肾素受体的血清水平被认为是反映组织肾素-血管紧张素-醛固酮系统活性的生物标志物。我们研究了单用阿利吉仑阻断肾素-血管紧张素-醛固酮系统对肾和血管功能的影响，并确定了血清可溶性（原）肾素受体水平是否是阿利吉仑对高血压伴慢性肾脏疾病患者疗效的预测因子。我们门诊的39例原发性高血压伴慢性肾脏病患者被随机分配接受阿利吉仑或阿利司他滨治疗。在治疗前和治疗12周和24周后，评价与肾和血管功能相关的参数以及肾素-血管紧张素-醛固酮系统组分的指数，包括可溶性形式的血清水平。两组之间的血压没有显著差异。在两组中均未观察到血清可溶性（原）肾素受体水平的显著变化。阿利吉仑组的尿白蛋白、蛋白排泄和心踝血管指数显著降低。在阿利吉仑组中，可溶性（原）肾素受体基础水平与血浆醛固酮浓度变化呈显著负相关。单用阿利吉仑阻断肾素-血管紧张素-醛固酮系统显示出不依赖于血压降低的肾脏和血管保护作用。可溶性（原）肾素受体的血清水平可能表明醛固酮的生产通过（原）肾素受体在肾上腺。
The (pro)renin receptor is important in the regulation of the tissue renin-angiotensin-aldosterone system. The benefits and safety of single-aliskiren treatment without other renin-angiotensin-aldosterone system inhibitors remain unclear. The serum level of the soluble form of the (pro)renin receptor is thought to be a biomarker reflecting the activity of the tissue renin-angiotensin-aldosterone system. We investigated the effects of single renin-angiotensin-aldosterone system blockade with aliskiren on renal and vascular functions and determined if serum level of the soluble (pro)renin receptor was a predictor of aliskiren efficacy in hypertensive patients with chronic kidney disease. Thirty-nine essential hypertensive patients with chronic kidney disease in our outpatient clinic were randomly assigned to receive either aliskiren or amlodipine. The parameters associated with renal and vascular functions and indices of renin-angiotensin-aldosterone system components, including serum levels of the soluble form, were evaluated before and after 12-week and 24-week treatment. Blood pressure was not significantly different between the groups. No significant changes in serum levels were observed in the soluble (pro) renin receptor in either group. Urinary albumin, protein excretion, and cardio-ankle vascular index significantly decreased in the aliskiren group. In the aliskiren group, there was a significant negative correlation between the basal level of the soluble (pro)renin receptor and the change in plasma aldosterone concentration. Single renin-angiotensin-aldosterone system blockade with aliskiren showed renal and vascular protective effects independent of blood pressure reduction. Serum levels of the soluble (pro)renin receptor may indicate aldosterone production via the (pro)renin receptor in the adrenal gland.