Podzolkov V I, Rodionov A V
Klin Med (Mosk). 2004;82(6):34-8.
The study was undertaken to examine whether the drugs affecting the renin-angiotensin system may be used in the combined treatment of patients with idiopathic hyperaldosteronism (IHA). The study covered 20 patients (mean age 46.6 +/- 7.3 years). The diagnosis in all the patients was verified by a complex of instrumental studies, including the determination of plasma aldosterone concentrations (PAC) and plasma renin activity (PRA), and topical diagnostic studies (ultrasonography, computed tomography (CT)/magnetic resonance imaging (MRI), and angiography). The patients were given spironolactone, dihydropyridine calcium blockers, and beta-adrenoblockers, then with the cross-over method, this combination was added by the angiotensin-I receptor blocker (ATRB) losartane or the angiotensin-converting enzyme inhibitor (ACEI) lisinopril for 4 weeks. 24-hour blood pressure (BP) monitoring was used to evaluate the efficiency of therapy. In the combined therapy losartane, 50-100 mg/day, reduced systolic BP (SBP) by 8.4%, diastolic BP (DBP) by 11.1% while lisinopril, 10-20 mg/day lowered SBP and DBP by 7.6 and 9.9%, respectively. Both drugs improved the daily BP profile. When losartane or lisinopril added to the combined treatment, a therapeutic response was achieved in 15 (79%) and 14 (73.7%) patients, respectively. ARB and ACEI exert an antihypertensive effect in patients with IHA and they may be used in the combined treatment of this disease. The use of the above drugs may reduce the dose of spironolactone to the mean therapeutic one. The pathophysiological rationale for the use of ATRB for IHA is that the sensitivity of aldosterone secretion to the stimulating effect of angiotensin II is preserved despite the fact that the PAC is higher and PRA is lower.
本研究旨在探讨影响肾素 - 血管紧张素系统的药物是否可用于特发性醛固酮增多症（IHA）患者的联合治疗。该研究涵盖了20名患者（平均年龄46.6±7.3岁）。所有患者的诊断均通过一系列仪器检查得以证实，包括血浆醛固酮浓度（PAC）和血浆肾素活性（PRA）的测定，以及局部诊断研究（超声检查、计算机断层扫描（CT）/磁共振成像（MRI）和血管造影）。给予患者螺内酯、二氢吡啶类钙通道阻滞剂和β - 肾上腺素能阻滞剂，然后采用交叉方法，在此联合用药基础上加用血管紧张素I受体阻滞剂（ATRB）氯沙坦或血管紧张素转换酶抑制剂（ACEI）赖诺普利，持续4周。采用24小时血压（BP）监测来评估治疗效果。在联合治疗中，氯沙坦每日50 - 100 mg可使收缩压（SBP）降低8.4%，舒张压（DBP）降低11.1%，而赖诺普利每日10 - 20 mg可使SBP和DBP分别降低7.6%和9.9%。两种药物均改善了每日血压情况。当在联合治疗中加入氯沙坦或赖诺普利时，分别有15名（79%）和14名（73.7%）患者获得了治疗反应。ARB和ACEI对IHA患者具有降压作用，可用于该疾病的联合治疗。使用上述药物可能将螺内酯的剂量降低至平均治疗剂量。IHA使用ATRB的病理生理依据是，尽管PAC较高且PRA较低，但醛固酮分泌对血管紧张素II刺激作用的敏感性仍然存在。
