Effectiveness of the selective aldosterone blocker, eplerenone, in patients with resistant hypertension
Effectiveness of the selective aldosterone blocker, eplerenone, in patients with resistant hypertension
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DOI：
10.1016/j.jash.2008.05.005
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发表时间：
2008-11-01
影响因子：
--
通讯作者：
White, William B.
中科院分区：
文献类型：
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作者：
Calhoun, David A.;White, William B.
顽固性高血压被定义为尽管使用至少三种抗高血压药物进行强化治疗但仍无法控制的高血压，其中理想的情况是利尿剂。为了确定选择性醛固酮拮抗剂依普利酮在这一人群中的有效性和安全性，我们研究了顽固性高血压患者（临床血压[BP]> 140 mm Hg收缩压或> 90 mm Hg舒张压，最大剂量超过三种抗高血压药物，包括袢利尿剂或噻嗪类利尿剂）。基线时和依普利农治疗 12 周后（每日滴定 50 至 100 毫克以达到效果）。患者接受了门诊和 24 小时血压测量、血清钾、血浆肾素活性和血清醛固酮测量。完成试验的患者 (n = 52) 平均年龄 62±10 岁，体重超重（平均体重指数，32.1 +/- 5.5 kg/m(2)），肾功能可变（肾小球滤过率。106 +/- 38 mL/分钟）； 70% 是男性，74% 是非黑人。基线时抗高血压药物的平均数量为 3.7 +/- 0.8（范围为 3 至 7 种药物），以实现 150.5/84.1 mm Ho 的临床血压。平均血清醛固酮为 12.9 +/- 7.6 ng/mL，血浆肾素活性为 2.3 +/- 2.7 ng/mL/小时。使用依普利酮后，诊所血压相对于基线的变化为 -17.6/-7.9 mm Hg（收缩压 [SBP] 和舒张压 [DBP] 的 P < .0001），24 小时血压为 -12.2/-6.0 mm Hg（两者的 P < .0001）。抗高血压药物的数量减少至 3.3 +/- 0.9（范围：1 至 7 种药物）。血浆钾增加 0.30 +/- 0.45 mEq/L (P < .001)，但两名轻度高钾血症患者中仅出现 3 例（钾 >5.5 mEq/L，但收缩压和舒张压均为 0.3，P < .0001），与基线血清醛固酮微弱相关（r = -0.30；P = .05）。且与血浆肾素活性、年龄、性别或种族无关。总之，依普利农在治疗难治性高血压方面表现出显着疗效，并且耐受性良好，血浆钾变化不大。血清醛固酮和血浆肾素活性不能预测该人群中血压对依普利酮的反应。 《美国社会高血压杂志》2008：2(6)：462-468。 (C) 2008 年美国高血压学会。版权所有。
Resistant hypertension is defined as uncontrolled hypertension despite intensive treatment with at least three anti hypertensive agents, one of which ideally should be a diuretic. To determine the efficacy and safety of the selective aldosterone antagonist eplerenone in this population, we studied patients with resistant hypertension (clinic blood pressure [BP] > 140 mm Hg systolic or >90 mm Hg diastolic on maximal doses of more than three antihypertensive agents, including a loop or thiazide diuretic). At baseline and after 12 weeks of eplerenone therapy (50 to 100 mg daily titrated to effect). patients underwent clinic and 24-hour BP measurements, serum potassium, plasma renin activity, and serum aldosterone measurements. Patients (n = 52) completing the trial averaged 62 10 years of age, were overweight (mean body mass index, 32.1 +/- 5.5 kg/m(2)) and had variable renal function (glomerular filtration rate. 106 +/- 38 mL/minute); 70% were men and 74% were non-Black. The mean number of antihypertensive agents at baseline was 3.7 +/- 0.8 (range, three to seven drugs) to achieve a clinic BP of 150.5/84.1 mm Ho. The mean serum aldosterone was 12.9 +/- 7.6 ng/mL and plasma renin activity was 2.3 +/- 2.7 ng/mL/hour. After eplerenone, the change from baseline in the clinic BP was -17.6/-7.9 mm Hg (P < .0001 for both systolic blood pressure [SBP] and diastolic blood pressure [DBP]) and in 24-hour BP was -12.2/-6.0 mm Hg (P < .0001 for both). The number of antihypertensive drugs decreased to 3.3 +/- 0.9 (range. one to seven agents). Plasma potassium increased by 0.30 +/- 0.45 mEq/L (P < .001), but there were only three instances in two patients of mild hyperkalemia (potassium >5.5 mEq/L, but 0.3 for both SBP and DBP, P < .0001), weakly related to baseline serum aldosterone (r = -0.30; P = .05). and unrelated to plasma renin activity, age, gender, or race. In conclusion, eplerenone demonstrated substantial efficacy in treatment-resistant hypertension and was well-tolerated with modest changes in plasma potassium. Serum aldosterone and plasma renin activity did not predict BP responses to eplerenone in this population. J Am Soc Hypertens 2008:2(6): 462-468. (C) 2008 American Society of Hypertension. All rights reserved.