Niutta E, Cusi D, Colombo R, Pellizzoni M, Cesana B, Barlassina C, Soldati L, Bianchi G
Istituto di Scienze Mediche, University of Milan, Italy.
J Hypertens Suppl. 1990 Sep;8(4):S53-8.
The efficacy of captopril at 75 mg/day, atenolol at 100 mg/day and canrenoate potassium at 200 mg/day was compared in 42 essential hypertensive patients in randomly assigned sequences. All the drugs lowered blood pressure significantly but variations were found in the individual response. Patients who were more responsive to captopril also seemed to be more responsive to atenolol and vice versa (r = 0.75; P less than 0.0001), while the relationship between mean blood pressure reached after canrenoate potassium and that reached after atenolol or captopril was much weaker. The patients who were responsive to atenolol and captopril were considered as one group (n = 22) and compared with the 12 patients more responsive to canrenoate potassium. Before treatment, the former group had higher plasma renin activity (PRA) and lower Na,K cotransport activity across the erythrocyte membrane than the latter. These two variables, considered together as a discriminant function, correctly classified 92% of cases in the canrenoate potassium responder group and 73% of cases in the atenolol-captopril responders. These results raise the problem of individual assessment to obtain the most effective antihypertensive therapy and suggest that PRA and Na,K cotransport may be useful in predicting the individual response to antihypertensive drugs.
对42例原发性高血压患者按照随机分配的顺序，比较了每日75毫克卡托普利、每日100毫克阿替洛尔和每日200毫克坎利酸钾的疗效。所有药物均能显著降低血压，但个体反应存在差异。对卡托普利反应较强的患者似乎对阿替洛尔反应也较强，反之亦然（r = 0.75；P < 0.0001），而坎利酸钾治疗后达到的平均血压与阿替洛尔或卡托普利治疗后达到的平均血压之间的关系则弱得多。将对阿替洛尔和卡托普利有反应的患者视为一组（n = 22），并与对坎利酸钾反应更强的12例患者进行比较。治疗前，前一组的血浆肾素活性（PRA）较高，红细胞膜上的钠钾协同转运活性低于后一组。将这两个变量作为判别函数综合考虑，能正确分类坎利酸钾反应组中92%的病例以及阿替洛尔-卡托普利反应组中73%的病例。这些结果提出了个体评估以获得最有效抗高血压治疗的问题，并表明PRA和钠钾协同转运可能有助于预测个体对抗高血压药物的反应。
