Abstract：Objective: To evaluate the efficacy and safety of low- dose spironolactone in elderly patients with refractory hypertension. Methods: In the hospital, 85 patients with RH were enrolled from May 2015 to December 2015, including 45 males and 40 females, aged 72.12 ± 6.34 years. They were randomly divided into test group and control group. On the basis of A + C + D regimen, the patients in the experimental group were treated with spironolactone 20mg / day, the control group was given placebo. Followed up for 8 weeks to observe the changes in blood pressure, serum potassium and serum creatinine. Results: In the experimental group, there were 2 cases of adverse reactions, 1 case of lost visit, a total of 3 cases of withdrawal test, the control group 1 case lost. The mean value of systolic blood pressure and diastolic blood pressure decreased significantly after 8 weeks follow-up. The difference was statistically significant (P <0.05); Potassium ion, serum creatinine increased significantly was statistically significant P <0.05; but not yet exceeded the normal reference value of the maximum. Conclusion: In elderly patients with refractory hypertension in the A + C + D treatment program based on the addition of low-dose spironolactone can effectively reduce systolic and diastolic blood pressure, and tolerance is better.
卢旭, 余蕾蕾, 陈光辉. 小剂量螺内酯在老年难治性高血压患者中的疗效及安全性分析[J]. 河北医学, 2017, 23(8): 1294-1300.
LU Xu, et al. Efficacy and Safety of Low-dose Spironolactone in Elderly Patients With Refractory Hypertension. 河北医学, 2017, 23(8): 1294-1300.
[1] Paul A,James,Suzanne Oparil,et al. 2014 Evidence-based guideline for the management of high blood pressure in adults report from the panel members appointed to the eighth joint national committee (JNC 8)[J].JAMA,2014,311(5):507~520. [2] 中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华心血管病杂志,2011,39(7):579~616. [3] Coppolino G, Rivoli L, Bolignano D. Renal denervation for resistant hypertension[M].The Cochrane Library. John Wiley & Sons, Ltd, 2015.636~638. [4] Achelrod D, Wenzel U, Frey S. Systematic review and meta-analysis of the prevalence of resistant hypertension in treated hypertensive populations[J].Am Hypertens,2015,28(3):355~361. [5] Mancia G1, Fagard R, Narkiewicz K,et al.2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)[J].Eur Heart,2013,34(28):2159. [6] NICE. NICE hypertension guideline CG127[J].https://www.nice.org.uk/guidance/cg127 (accessed May 26, 2015). [7] O’Brien E, Waeber B, Parati G, et al.MG,.Blood pressure measuring devices: recommendations of the European Society of Hypertension[J].BMJ,2001,322(7285):531~536. [8] Forouzanfar MH, Afshin A, Alexander LT, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015[J].Lancet,2016,388(10053):1659~1724. [9] 陈伟伟,高润霖,刘力生,等.《中国心血管病报告2016》概要[J].中国循环杂志,2017,32(6):617~622. [10] Daugherty SL, Powers JD, Magid DJ, et al.Incidence and prognosis of resistant hypertension in hypertensive patients[J].Circulation,2012,125(13):1635~1642. [11] Fagard RH. Resistant hypertension[J].Heart,2012,98(3):254~261. [12] 孙宁玲,霍勇,王继光,等.难治性高血压诊断治疗中国专家共识[J].中华高血压杂志,2013,21:321~326. [13] Vasan RS,Evans JC,Larson MG,et al. Serum aldosterone and the incidence of hypertension in nonhypertensive persons[J].N Engl Med,2004,351(1):33~41. [14] Sartori M,Calo LA,Mascagna V,et al. Aldosteroneandrefractory hypertension:a prospective cohort study[J].Hypertension,2006,19(4):373~379. [15] Bomback AS,Klemmer PJ.The incidence and implications of aldosterone breakthrough[J].Nat Clin Pract Nephrol,2007,3(9):486~492. [16] Young MJ.Mechanisms of mineralocorticoid receptor-mediated cardiac fibrosisand vascular inflammation[J].Curr Opin Nephrol Hypertens,2008,17(2):174~180. [17] Gross E,Rothstein M,Dombek S,et al. Effect of spironolactone on bloodpressure and the renin-angiotensin-aldosterone system in oligoanuric hemodialysispatients[J].Am Kidney Dis,2005,46(1):94~101. [18] Rahmouni K,Sibug RM, Kloet ER,et al.Effects of brain mineralocorticoidreceptor blockade on blood pressure and renal functions in DOCA-salt hypertension[J].Eur Pharmacol,2002,436(3):207~216. [19] Chai W,Garrelds IM,Vries R,et al.Nongenomic effects of aldosterone inthe human heart: interaction with angiotensin Ⅱ[J].Hypertension,2005,46(4): 701~706. [20] Duprez DA,Cohn JN.Arterial stiffness as a risk factor for coronary atherosclerosis[J].Curr Atheroscler Rep,2007,9(2):139~144. [21] Lindgren P, Buxton M, Kahan T, et al. Economic evaluation of ASCOT-BPLA: antihypertensive treatment with an amlodipine-based regimen is cost effective compared with an atenolol-based regimen[J].Heart, 2008, 94(2):e4. [22] Václavík J1, Sedlák R, Plachy M,et al. Addition of spironolactone in patients with resistant arterial hypertension (ASPIRANT): a randomized, double-blind, placebo-controlled trial[J].Hypertension,2011,57(6):1069~1075. [23] Chapman N, Dobson J, Wilson S, Dahlof B, Sever PS, Wedel H,et al. Effect of spironolactone on blood pressure in subjects with resistant hypertension[J].Hypertension,2007,49(4):839~845. [24] Williams B, MacDonald TM, Morant S et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial[J].Lancet,2015,386(10008):2059~2068.
2017, Vol. 23 
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