Kojima S, Shida M, Takano H, Inami S, Yodogawa K, Yokoyama H, Kuramochi M
Department of Clinical Research, Tohsei National Hospital, Shizuoka, Japan.
Hypertens Res. 2001 Sep;24(5):595-8. doi: 10.1291/hypres.24.595.
In a patient who was taking an angiotensin-converting-enzyme inhibitor, low-density lipoprotein (LDL) apheresis with dextran-sulfate cellulose provoked hypotension accompanied by lacrimation and blurred vision. Hypotension was eliminated by changing the anticoagulant from heparin to a protease inhibitor, nafamostat mesilate. A study was undertaken to clarify whether an antagonist of angiotensin type 1-receptor, losartan, could be safely used in the same patient during LDL apheresis treatment. Blood pressure and humoral factors were compared between the apheresis sessions with losartan and those without. Although angiotensin II and bradykinin plasma levels during LDL apheresis were significantly greater with losartan than without, blood pressure reduction by losartan was mild and unpleasant symptoms were not induced. Losartan was thus safely used for this patient during treatment by LDL apheresis. The greater rise in bradykinin levels during apheresis with losartan might be ascribable to angiotensin type 2-receptor stimulation.
在一名正在服用血管紧张素转换酶抑制剂的患者中，使用硫酸葡聚糖纤维素进行低密度脂蛋白（LDL）单采引发了低血压，并伴有流泪和视力模糊。通过将抗凝剂从肝素改为蛋白酶抑制剂甲磺酸萘莫司他，低血压得以消除。开展了一项研究，以阐明血管紧张素1受体拮抗剂氯沙坦在该患者进行LDL单采治疗期间是否可以安全使用。对使用氯沙坦进行单采的疗程和未使用氯沙坦进行单采的疗程之间的血压和体液因子进行了比较。尽管使用氯沙坦进行LDL单采期间血浆血管紧张素II和缓激肽水平显著高于未使用氯沙坦时，但氯沙坦引起的血压降低较为轻微，且未诱发不适症状。因此，氯沙坦在该患者进行LDL单采治疗期间被安全使用。使用氯沙坦进行单采期间缓激肽水平的更大升高可能归因于血管紧张素2受体刺激。
