Effective uric acid-lowering treatment for hypertensive patients with hyperuricemia
Effective uric acid-lowering treatment for hypertensive patients with hyperuricemia
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DOI：
10.1038/hr.2016.139
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发表时间：
2017-03-01
影响因子：
5.4
通讯作者：
Kawano, Yuhei
中科院分区：
文献类型：
--
作者：
Ohta, Yuko;Ishizuka, Azusa;Kawano, Yuhei
尿酸（UA）与高血压、肾脏疾病和心血管疾病有关。本研究的目的是比较标准剂量的尿酸合成抑制剂非布司他与标准剂量的尿酸排泄剂苯溴马隆的尿酸降低作用，并研究两种药物低剂量联合治疗高血压伴高尿酸血症患者的效果。20例UA控制不佳的高血压患者以随机改良交叉方式接受非布司他40 mg（Feb）、苯溴马隆50 mg（Ben）和非布司他20 mg和苯溴马隆25 mg（Feb/ben）治疗3个月。分别于治疗前和治疗结束时测定尿酸代谢、血压和脏器损害指数。在每种UA降低方案治疗后，未观察到血压或估计肾小球滤过率（eGFR）的显著变化。尿酸的变化与feb/ ben显著大于2月。尿酸的排泄和清除与本高于Feb和feb/ ben。尿8-羟基脱氧鸟苷和肝型脂肪酸结合蛋白水平略低于本，而流量介导的扩张略高于与feb/ ben和本。UA合成抑制剂和促尿酸排泄剂的低剂量组合的UA降低作用大于标准剂量的每种药剂单独的UA降低作用。促尿酸排泄剂在改善血管功能方面可能比尿酸合成抑制剂更有效。因此，适当的治疗高尿酸血症的促尿酸药物似乎是有益的高血压患者的高尿酸血症。
Uric acid (UA) has been associated with hypertension, renal disease and cardiovascular disease. The aim of the present study was to compare the UA-lowering effects of a standard dose of the UA synthesis inhibitor febuxostat to a standard dose of the uricosuric agent benzbromarone, and to investigate the effects of a low-dose combination of both agents in hypertensive patients with hyperuricemia. Twenty hypertensive patients with inadequate UA control were administered febuxostat 40 mg (Feb), benzbromarone 50 mg (Ben) and febuxostat 20 mg and benzbromarone 25 mg (feb/ben) for 3 months each in a randomized modified crossover manner. UA metabolism, blood pressure (BP) and the indices of organ damage were assessed at baseline and the end of each treatment period. No significant changes were observed in BP or estimated glomerular filtration rate (eGFR) after the treatment with each UA-lowering regimen. The change in UA was significantly greater with feb/ ben than with Feb. The excretion of UA and clearance of UA were higher with Ben than with Feb and feb/ ben. Urinary 8-hydroxydeoxyguanosine and liver-type fatty-acid-binding protein levels were slightly lower with Ben, whereas flow-mediated dilation was slightly higher with feb/ ben and Ben. The UA-lowering effects of the low-dose combination of the UA synthesis inhibitor and uricosuric agent were greater than those of the standard dose of each agent alone. The uricosuric agent may be more effective at improving vascular function than the UA synthesis inhibitor. Thus, the appropriate management of hyperuricemia with uricosuric drugs appears to be useful for hypertensive patients with hyperuricemia.