Edwards Nicola C, Steeds Richard P, Stewart Paul M, Ferro Charles J, Townend Jonathan N
Department of Cardiology, University Hospital Birmingham and University of Birmingham, Birmingham, UK.
J Am Coll Cardiol. 2009 Aug 4;54(6):505-12. doi: 10.1016/j.jacc.2009.03.066.
We sought to determine whether the addition of spironolactone to angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) improves left ventricular mass and arterial stiffness in early-stage chronic kidney disease (CKD).
Chronic kidney disease is associated with a high risk of cardiovascular disease and a high prevalence of left ventricular hypertrophy and arterial stiffness that confer an adverse prognosis. It is believed that these abnormalities are in part a result of activation of the renin-angiotensin-aldosterone system.
After an active run-in phase with spironolactone 25 mg once daily, 112 patients with stage 2 and 3 CKD with good blood pressure control (mean daytime ambulatory blood pressure <130/85 mm Hg) on established treatment with ACE inhibitors or ARBs were randomized to continue spironolactone or to receive a matching placebo. Left ventricular mass (cardiac magnetic resonance) and arterial stiffness (pulse wave velocity/analysis, aortic distensibility) were measured before run in and after 40 weeks of treatment.
Compared with placebo, the use of spironolactone resulted in significant improvements in left ventricular mass (-14 +/- 13 g vs. +3 +/- 11 g, p < 0.01), pulse wave velocity (-0.8 +/- 1.0 m/s vs. -0.1 +/- 0.9 m/s, p < 0.01), augmentation index (-5.2 +/- 6.1% vs. -1.4 +/- 5.9%, p < 0.05), and aortic distensibility (0.69 +/- 0.86 x 10(-3) mm Hg vs. 0.04 +/- 1.04 x 10(-3) mm Hg, p < 0.01).
The use of spironolactone reduces left ventricular mass and improves arterial stiffness in early-stage CKD. These effects suggest that aldosterone exerts adverse cardiovascular effects in CKD and that spironolactone is worthy of further study as a treatment that could reduce adverse cardiovascular events. (Is Spironolactone Safe and Effective in the Treatment of Cardiovascular Disease in Mild Chronic Renal Failure; NCT00291720).
我们旨在确定在血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB）基础上加用螺内酯是否能改善早期慢性肾脏病（CKD）患者的左心室质量和动脉僵硬度。
慢性肾脏病与心血管疾病高风险相关，左心室肥厚和动脉僵硬度患病率高，这些情况预后不良。据信这些异常部分是肾素 - 血管紧张素 - 醛固酮系统激活的结果。
在每日一次服用25mg螺内酯的活性导入期后，112例2期和3期CKD患者，在使用ACE抑制剂或ARB进行既定治疗且血压控制良好（平均日间动态血压<130/85mmHg），被随机分组，继续使用螺内酯或接受匹配的安慰剂。在导入期前和治疗40周后测量左心室质量（心脏磁共振）和动脉僵硬度（脉搏波速度/分析，主动脉扩张性）。
与安慰剂相比，使用螺内酯可显著改善左心室质量（-14±13g对+3±11g，p<0.01）、脉搏波速度（-0.8±1.0m/s对-0.1±0.9m/s，p<0.01）、增强指数（-5.2±6.1%对-1.4±5.9%，p<0.05）和主动脉扩张性（0.69±0.86×10⁻³mmHg对0.04±1.04×10⁻³mmHg，p<0.01）。
在早期CKD中，使用螺内酯可减轻左心室质量并改善动脉僵硬度。这些作用表明醛固酮在CKD中发挥不良心血管作用，螺内酯作为一种可减少不良心血管事件的治疗方法值得进一步研究。（螺内酯治疗轻度慢性肾衰竭心血管疾病是否安全有效；NCT00291720）
