Lim P O, Jung R T, MacDonald T M
Hypertension Research Centre, Department of Clinical Pharmacology and Therapeutics, and Department of Endocrinology and Diabetes, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
Br J Clin Pharmacol. 1999 Nov;48(5):756-60. doi: 10.1046/j.1365-2125.1999.00070.x.
Aldosterone/renin ratio is an index for inappropriate aldosterone activity, and it is increasingly being used to screen for primary aldosteronism within the hypertensive population. It may also be a good index to help predict the response to spironolactone. To assess the blood pressure response to oral spironolactone in hypertensive patients with primary aldosteronism identified with raised aldosterone to renin ratio.
We conducted a prospective cohort study of hypertensive patients with raised aldosterone/renin ratio, who failed to suppress plasma aldosterone with salt loading and fludrocortisone suppression test. These patients were treated with spironolactone and were followed-up for a period of up to 3 years.
We studied 28 (12 male) subjects with a mean age of 55 (s.d. 10) years who were followed up for a mean period of 12.9 (7) months. At baseline, the patients were taking a mean of 2.1 (1.2) antihypertensive drugs, but despite this 16/28 (57%) had diastolic BP >90 mmHg, 39% with systolic BP >160 mmHg. After commencing spironolactone, three patients complained of breast tenderness but continued treatment and one patient was intolerant of spironolactone and had to stop treatment. Of the remaining 27 patients, the mean number of antihypertensive drugs used dropped to spironolactone plus 0.7 (s.d. 0.9). All but one patient (96%) achieved a diastolic BP</=90 mmHg and 78% achieved a systolic BP</=160 mmHg. In total 48% had BP</=140/90 mmHg and 13/27 (48%) were treated with spironolactone monotherapy. Assessing only patients on drug treatment at baseline (n=24), spironolactone significantly reduced the need for antihypertensive drugs by -0.5 (CI 0.1-1.0), P=0.02, as well as reducing blood pressure [systolic BP -15 mmHg (CI 5-25), P=0.007 and diastolic BP (mmHg) by -8 mmHg (CI 4-13), P=0.001].
Spironolactone was a highly effective antihypertensive agent in hypertensive patients who had a raised aldosterone/renin ratio. As a raised ratio was highly predictive of nonsuppression of plasma aldosterone suggesting primary aldosteronism, it might be worthwhile using spironolactone in this subgroup of hypertensive patients with raised aldosterone/renin ratios, provided that adrenal adenomas are excluded with imaging techniques.
醛固酮/肾素比值是醛固酮活性异常的一个指标，越来越多地用于在高血压人群中筛查原发性醛固酮增多症。它也可能是有助于预测对螺内酯反应的良好指标。评估醛固酮/肾素比值升高的原发性醛固酮增多症高血压患者口服螺内酯后的血压反应。
我们对醛固酮/肾素比值升高、盐负荷和氟氢可的松抑制试验未能抑制血浆醛固酮的高血压患者进行了一项前瞻性队列研究。这些患者接受螺内酯治疗，并随访长达3年。
我们研究了28名（12名男性）平均年龄为55（标准差10）岁的受试者，平均随访时间为12.9（7）个月。基线时，患者平均服用2.1（1.2）种降压药，但尽管如此，16/28（57%）的患者舒张压>90 mmHg，39%的患者收缩压>160 mmHg。开始服用螺内酯后，3名患者抱怨乳房压痛但继续治疗，1名患者不耐受螺内酯而不得不停药。其余27名患者中，使用的降压药平均数量降至螺内酯加0.7（标准差0.9）种。除1名患者外（96%），所有患者舒张压≤90 mmHg，78%的患者收缩压≤160 mmHg。共有48%的患者血压≤140/90 mmHg，13/27（48%）的患者接受螺内酯单药治疗。仅评估基线时接受药物治疗的患者（n = 24），螺内酯显著减少了降压药的需求，减少量为-0.5（可信区间0.1 - 1.0），P = 0.02，同时降低了血压[收缩压降低15 mmHg（可信区间5 - 25），P = 0.007，舒张压降低8 mmHg（可信区间4 - 13），P = 0.001]。
螺内酯对醛固酮/肾素比值升高的高血压患者是一种高效的降压药物。由于比值升高高度预测血浆醛固酮不被抑制，提示原发性醛固酮增多症，对于醛固酮/肾素比值升高的这一亚组高血压患者，在通过影像学技术排除肾上腺腺瘤的情况下，使用螺内酯可能是值得的。
