Medicine and Pharmacology, Clinical Pharmacology and Hypertension, Richmond, USA.
Curr Cardiol Rep. 2011 Dec;13(6):520-6. doi: 10.1007/s11886-011-0224-z.
Resistant hypertension has evolved as an important global health care problem. Primary aldosteronism is one of several potentially reversible causes of resistant hypertension. Primary aldosteronism can be effectively treated, when recognized, with a mineralocorticoid receptor antagonist, such as spironolactone and eplerenone. Each of these compounds can reduce blood pressure as monotherapy or when given with a range of other antihypertensive drug classes. These compounds have distinctive pharmacokinetic and pharmacodynamic patterns that require some forethought in their use before they are prescribed. However, as the use of mineralocorticoid-blocking agents has gradually increased, the hazards inherent to use of such drugs has become more apparent. Whereas the endocrine side effects of spironolactone are in most cases little more than a cosmetic annoyance, the potassium-sparing effects of both spironolactone and eplerenone can prove fatal if sufficient degrees of hyperkalemia develop. However, for most patients the risk of developing hyperkalemia in and of itself should not discourage the prudent clinician from bringing these compounds into play. Hyperkalemia should always be considered as a likelihood in any patient receiving one or the other of these medications. As such, steps should be taken to lessen the likelihood of it occurring if therapy is being contemplated with agents in this class.
抗药性高血压已成为一个重要的全球医疗保健问题。原发性醛固酮增多症是几种潜在可逆转的抗药性高血压病因之一。当被识别时，原发性醛固酮增多症可以用盐皮质激素受体拮抗剂（如螺内酯和依普利酮）有效治疗。这些化合物中的每一种都可以作为单一疗法或与一系列其他降压药物类别一起使用来降低血压。这些化合物具有独特的药代动力学和药效动力学模式，在开处方之前需要一些预先考虑。然而，随着盐皮质激素阻断剂的使用逐渐增加，使用这些药物所固有的危险变得更加明显。虽然螺内酯的内分泌副作用在大多数情况下只不过是一种美容上的烦恼，但螺内酯和依普利酮的保钾作用如果发展到足够程度的高钾血症，就可能是致命的。然而，对于大多数患者来说，高钾血症本身的风险不应阻止谨慎的临床医生将这些化合物应用于治疗。在任何接受这些药物之一的患者中，都应始终考虑高钾血症的可能性。因此，如果正在考虑使用此类药物进行治疗，应采取措施降低其发生的可能性。
