Pressor Responses to Antihypertensive Drug Types
Pressor Responses to Antihypertensive Drug Types
复制标题
DOI：
10.1038/ajh.2010.114
复制
发表时间：
2010-09-01
影响因子：
3.2
通讯作者：
Laragh, John H.
中科院分区：
文献类型：
--
作者：
Alderman, Michael H.;Cohen, Hillel W.;Laragh, John H.
背景：降压药对血压的反应在治疗指南中没有提到，尽管在各种临床情况下都有描述。我们现在报道了在一个以工作场所为基础的降压治疗项目的参与者中，开始使用四种降压药物类型的单一治疗时的降压反应发生率，以及血浆肾素活性（PRA）状态的影响。方法：对945名既往未接受治疗的受试者进行收缩压（SBP）反应评估，这些受试者使用利尿剂或钙通道阻滞剂（利钠抗容量V药物，n = 537）或受体阻滞剂或血管紧张素转换酶（ACE）抑制剂（抗肾素R药物，n = 408）。PRA按低、中、高三位数（L、M、H）分类。收缩压升高= 10 mm Hg视为血压升高。结果R组出现的降压反应多于V组（11% vs. 5%, P = 0.001）。L、M和H肾素四分位与V药物的频率相似（分别为6、4和6%），但给予R的低、中四分位的加压频率更高（17% P = 0.003 vs. V, 10% P = 0.02 vs. V）。收缩压= 160 mm Hg的R组比V组更常见（19% vs. 13%; P = 0.007）；此外，在肾素水平最低的组中，35% R对13% V （P = 0.001）的收缩压= 160 mm Hg。收缩压< 130 mm Hg在最低水平的V患者中更常见（18%对5%，P = 0.003），在最高水平的R患者中更常见（26%对12%，P = 0.002）。结论：单药降压治疗中出现的抗压反应足够频繁，值得关注，特别是在接受β受体阻滞剂或ACE抑制剂（ACEI）治疗的低肾素患者中。
BACKGROUNDPressor responses to antihypertensive drugs are not addressed in treatment guidelines although they have been described in various clinical situations. We now report the incidence of pressor responses to initiation of monotherapy using four antihypertensive drug types, and the influence of plasma renin activity (PRA) status, among participants in a worksite-based antihypertensive treatment program.METHODSSystolic blood pressure (SBP) response was evaluated among 945 participants with no prior treatment who were given either a diuretic or calcium-channel blocker (natriuretic antivolume V drugs, n = 537) or a beta-blocker or angiotensin-converting enzyme (ACE) inhibitor (antirenin R drugs n = 408). PRA was categorized by low, middle, and high tertiles (L, M, and H). SBP rise = 10 mm Hg was considered pressor.RESULTSMore pressor responses occurred with R than V drugs (11% vs. 5%, P = 0.001). L, M, and H renin tertiles had similar frequencies with V drugs (6, 4, and 6%), but low and middle tertiles given R had greater pressor frequencies (17% P = 0.003 vs. V and 10% P = 0.02 vs. V). Treatment SBP = 160 mm Hg occurred more frequently with R than V drugs (19% vs. 13%; P = 0.007); moreover, in the lowest renin tertile 35% R vs. 13% V (P = 0.001) had SBP = 160 mm Hg. Treatment SBP < 130 mm Hg was more frequent in V patients in the lowest tertile (18% vs. 5%; P = 0.003), and in R patients in the highest tertile (26% vs. 12%, P = 0.002).CONCLUSIONSPressor responses to antihypertensive monotherapy occur sufficiently frequently to be of concern, especially in lower renin patients given a beta-blocker or ACE inhibitor (ACEI).