Fogari Roberto, Zoppi Annalisa, Carretta Renzo, Veglio F, Salvetti Antonio
Dipartimento di Medicina Interna, IRCCS Policlinico S. Matteo, Università di Pavia, Pavia, Italy.
J Hypertens. 2002 May;20(5):1007-14. doi: 10.1097/00004872-200205000-00037.
To compare the effect on antihypertensive efficacy produced by the addition of indomethacin to the angiotensin II (Ang II) antagonist, valsartan, or to the angiotensin-converting enzyme inhibitor, lisinopril, in hypertensive patients with chronic osteoarthritis.
One hundred and twenty-eight patients (52 men and 76 women) aged 25-82 years (mean age 55.7 years), with diastolic blood pressure (DBP) > 100 mmHg at the end of a 2-week placebo washout period were allocated randomly to groups to receive valsartan (80-160 mg once daily) or lisinopril (10-20 mg once daily). At the end of 10 weeks of treatment, patients with DBP < 90 mmHg, while continuing to receive valsartan or lisinopril treatment, were allocated randomly to groups to receive either indomethacin (50 mg three times a day) or the corresponding placebo for 2 weeks, with a 1-week washout period between the two treatments, according to a double-blind, crossover design. After the initial washout period, patients were examined at the end of the 4th, 8th and 10th weeks of randomized treatment with valsartan and lisinopril, at the end of the first crossover period and then at the beginning and at the end of the second crossover period. At each visit, sitting and standing blood pressure were measured by standard mercury sphygmomanometer.
The addition of indomethacin blunted the blood pressure-decreasing effect of both antihypertensive drugs. Although indomethacin produced greater increases in both systolic and DBP values in the lisinopril-treated patients (5.45/3.22 mmHg) than in the valsartan-treated ones (2.12/1.87 mmHg), no significant difference between the two drugs was found.
From a theoretical standpoint, these findings suggest that prostaglandins may play a part in the antihypertensive action of Ang II antagonists. From a practical standpoint, hypertensive patients treated with valsartan or with lisinopril should be monitored to detect changes in blood pressure control while receiving indomethacin.
比较在患有慢性骨关节炎的高血压患者中，加用吲哚美辛于血管紧张素II（Ang II）拮抗剂缬沙坦或血管紧张素转换酶抑制剂赖诺普利后对降压疗效的影响。
128例年龄在25 - 82岁（平均年龄55.7岁）的患者（52例男性和76例女性），在为期2周的安慰剂洗脱期结束时舒张压（DBP）> 100 mmHg，被随机分组接受缬沙坦（80 - 160 mg每日一次）或赖诺普利（10 - 20 mg每日一次）治疗。在治疗10周结束时，DBP < 90 mmHg且继续接受缬沙坦或赖诺普利治疗的患者，根据双盲交叉设计，被随机分组接受吲哚美辛（50 mg每日三次）或相应安慰剂治疗2周，两种治疗之间有1周的洗脱期。在初始洗脱期后，在缬沙坦和赖诺普利随机治疗的第4、8和10周结束时、第一个交叉期结束时以及第二个交叉期开始和结束时对患者进行检查。每次就诊时，使用标准汞柱血压计测量坐位和立位血压。
加用吲哚美辛减弱了两种降压药物的降压效果。尽管吲哚美辛使接受赖诺普利治疗的患者收缩压和DBP值升高幅度（5.45/3.22 mmHg）大于接受缬沙坦治疗的患者（2.12/1. August 7 mmHg），但两种药物之间未发现显著差异。
从理论角度来看，这些发现表明前列腺素可能在Ang II拮抗剂的降压作用中发挥作用。从实际角度来看，接受缬沙坦或赖诺普利治疗的高血压患者在服用吲哚美辛时应进行监测，以检测血压控制情况的变化。
