COMPARISON OF PROPRANOLOL OR HYDROCHLOROTHIAZIDE ALONE FOR TREATMENT OF HYPERTENSION .3. EVALUATION OF THE RENIN-ANGIOTENSIN SYSTEM
COMPARISON OF PROPRANOLOL OR HYDROCHLOROTHIAZIDE ALONE FOR TREATMENT OF HYPERTENSION .3. EVALUATION OF THE RENIN-ANGIOTENSIN SYSTEM
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DOI：
10.1016/0002-9343(83)90812-4
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发表时间：
1983-01-01
影响因子：
5.9
通讯作者：
FLAMENBAUM, W
中科院分区：
文献类型：
--
作者：
FREIS, ED;MATERSON, BJ;FLAMENBAUM, W
在这项研究中，肾素活性和治疗反应的氢氯噻嗪或普萘洛尔之间的关系进行了研究。舒张压为95-114 mm Hg的患者接受普萘洛尔（40-320 mg，每日两次）或氢氯噻嗪（25-100 mg，每日两次）治疗。初始的肾素曲线如下：低：56%（n = 300）;正常，33%（n = 174）;和高，11%（n = 60）。在黑人中观察到低肾素谱的发生率更高，高肾素谱的发生率更少（P < 0.001）。在呋塞米[一种利尿剂]给药（40 mg静脉注射）后，55%的患者（n = 291）具有低的肾素反应，45%（n = 240）具有正常的肾素反应。未观察到肾素谱和肾素反应之间的相关性，尽管低肾素反应和低肾素谱在老年患者中更常见。氢氯噻嗪给药导致总组舒张压下降幅度更大（P < 0.05）。不管肾素活性如何，氢氯噻嗪和普萘洛尔都能降低舒张压。当考虑到肾素谱时，未观察到对氢氯噻嗪治疗的反应的显著变化，并且在接受普萘洛尔的高肾素谱患者中舒张压降低更大。在比较治疗反应时，低肾素患者对氢氯噻嗪的反应更好，普萘洛尔对高肾素患者更有效。观察治疗对血浆肾素活性的预期影响。虽然这些结果与高血压的容积-血管收缩剂分析一致，但不能从肾素谱或反应性预先判断治疗结果。当简单测定治疗反应就足够时，观察到的微小差异不足以证明测定肾素的费用。
In this study, the relation between renin activity and therapeutic response to hydrochlorothiazide or propranolol was studied. Patients with a diastolic blood pressure of 95-114 mm Hg were treated with propranolol (40-320 mg twice daily) or hydrochlorothiazide (25-100 mg twice daily). The initial renin profiles were the following low: 56% (n = 300); normal, 33% (n = 174); and high, 11% (n = 60). A greater incidence of low and fewer high renin profiles (P < 0.001) were observed in blacks. After furosemide [a diuretic] administration (40 mg i.v.), 55% of patients (n = 291) had a low renin response and 45% (n = 240) had a normal renin response. No correlation between renin profile and renin response was observed, although low renin response and low renin profile occurred more frequently in older patients. Hydrochlorothiazide administration resulted in a greater decrement in diastolic blood pressure (P < 0.05) in the total group. Irrespective of renin activity, both hydrochlorothiazide and propranolol reduced diastolic blood pressure. When renin profile was considered, no significant variation in response to hydrochlorothiazide therapy was observed, and there was a greater reduction in diastolic blood pressure in the patients with a high renin profile receiving propranolol. In comparing therapeutic response, patients with a low renin profile had a better response to hydrochlorothiazide, and propranolol was more effective in patients with a high renin profile. The anticipated effect of therapy on plasma renin activity was observed. Although these results are consistent with a volume-vasoconstrictor analysis of hypertension, the results of therapy could not have been prejudged from renin profile or responsivity. The slight differences observed do not warrant the expense of renin determinations when a simple determination of therapeutic response is sufficient.