血清醛固酮与血浆肾素活性比值能否预测利尿剂在高血压中的疗效？RENALDO 研究结果。

Does the ratio of serum aldosterone to plasma renin activity predict the efficacy of diuretics in hypertension? Results of RENALDO.

机构信息

Department of Cardiology, Papworth Hospital, Cambridge, UK.

出版信息

J Hypertens. 2010 Jan;28(1):170-7. doi: 10.1097/HJH.0b013e328332b79b.

DOI:10.1097/HJH.0b013e328332b79b

PMID:20009770

Abstract

OBJECTIVES

We hypothesized that the aldosterone: renin ratio (ARR) predicts the antihypertensive response to mineralocorticoid receptor antagonist, spironolactone (SPIRO), when compared with bendroflumethiazide (BFZ).

METHODS

We conducted a randomized, crossover, trial on hypertensive patients with either high ARR (HARR defined as >750 and plasma aldosterone >250 pmol/l) or low ARR (LARR defined as <300 and plasma renin activity <10 ng/ml per h). Each group took SPIRO 50 mg once daily for 12 weeks and BFZ 2.5 mg once daily for 12 weeks in random order separated by 2-week washout. Patients with mean 24-h systolic ambulatory blood pressure (SABP) at least 140 mmHg were included. Primary endpoint was difference in SABP between SPIRO and BFZ in patients with HARR compared with those with LARR.

RESULTS

One hundred and eleven patients (60 HARR and 51 LARR) completed the study. SABP at 12 weeks in the HARR group was 129.4 mmHg on SPIRO and 134.4 mmHg on BFZ [difference -5.01; 95% confidence interval (CI) -7.51, -2.52; P < 0.0002]. In the LARR group, SABP was 129.7 mmHg on SPIRO and 133.1 mmHg on BFZ [difference -3.43 (95% CI -6.18, -0.68) P < 0.01]. Difference between groups (HARR vs. LARR) was -1.58 mmHg (95% CI 5.25, -2.08; not significant, P = 0.394). In a secondary analysis of the overall study population of 111 patients, SABP reduction with SPIRO 50 mg was superior to BFZ 2.5 mg [SPIRO -14.8 mmHg, BFZ -10.5 mmHg, difference -4.29 mmHg (95% CI -6.12, -2.46)]. Results were similar for secondary endpoints. Plasma renin activity or aldosterone did not predict blood pressure response to SPIRO. Results were independent of concomitant angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use.

CONCLUSION

The ARR did not predict the blood pressure response to SPIRO. SPIRO 50 mg was significantly more effective than BFZ 2.5 mg in lowering SABP irrespective of baseline ARR, plasma renin activity or aldosterone.

摘要

目的

我们假设醛固酮与肾素比值（ARR）在预测抗高血压药物反应方面优于苯氟噻嗪（BFZ），当与螺内酯（SPIRO）比较时。

方法

我们对高血压患者进行了一项随机、交叉、试验，这些患者的 ARR 较高（HARR 定义为>750 和血浆醛固酮>250 pmol/L）或 ARR 较低（LARR 定义为<300 和血浆肾素活性<10 ng/ml/小时）。每组患者均服用 SPIRO 50 mg 每日一次，共 12 周，然后服用 BFZ 2.5 mg 每日一次，共 12 周，两者之间有 2 周的洗脱期。纳入的患者平均 24 小时收缩压（SABP）至少为 140 mmHg。主要终点是与 LARR 患者相比，HARR 患者中 SPIRO 和 BFZ 之间 SABP 的差异。

结果

111 名患者（60 名 HARR 和 51 名 LARR）完成了这项研究。HARR 组在服用 SPIRO 12 周时的 SABP 为 129.4 mmHg，服用 BFZ 时为 134.4 mmHg[差异-5.01；95%置信区间（CI）-7.51，-2.52；P<0.0002]。在 LARR 组中，服用 SPIRO 时的 SABP 为 129.7 mmHg，服用 BFZ 时为 133.1 mmHg[差异-3.43（95%CI-6.18，-0.68）P<0.01]。组间差异（HARR 与 LARR）为-1.58 mmHg（95%CI 5.25，-2.08；无统计学意义，P=0.394）。在对 111 名患者的总体研究人群进行的二次分析中，SPIRO 50 mg 的 SABP 降低优于 BFZ 2.5 mg[SPIRO-14.8 mmHg，BFZ-10.5 mmHg，差异-4.29 mmHg（95%CI-6.12，-2.46）]。次要终点的结果相似。血浆肾素活性或醛固酮不能预测 SPIRO 的血压反应。结果独立于同时使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂。