Department of Cardiology and Internal Medicine, Fukuoka Red Cross Hospital, Fukuoka, Japan.
Clin Drug Investig. 2012 Mar 1;32(3):171-8. doi: 10.2165/11597620-000000000-00000.
Although strict blood pressure (BP) control is effective in the prevention of cardiovascular events, it is often insufficient in many hypertensive patients. B-type natriuretic peptide (BNP) has been shown to be associated with cardiovascular events. We investigated the effects of the losartan/hydrochlorothiazide combination on BP and plasma BNP in hypertensive patients uncontrolled by an angiotensin II type 1 receptor antagonist (angiotensin receptor blocker [ARB])-based therapy.
In a multicentre prospective observational study, we enrolled 185 patients aged 36-79 years (mean age 63.8 years) with essential hypertension but without symptoms of heart failure who received an ARB-based therapy for ≥3 months but failed to achieve a target BP recommended by the Japanese Society of Hypertension (JSH). ARBs were switched to losartan (LOS) 50 mg/hydrochlorothiazide (HCTZ) 12.5 mg. The antihypertensive efficacy, safety, and effects of this combination on blood biochemical parameters and plasma BNP were evaluated for 12 months.
Mean ± SD systolic and diastolic BP decreased from 152 ± 13/87 ± 10 mmHg to 128 ± 14/74 ± 10 mmHg, respectively, after 12 months (p < 0.001). Mean ± SD plasma BNP levels decreased significantly from 46.0 ± 83.0 pg/mL to 40.8 ± 68.0 pg/mL (p < 0.05). The percentage of patients who achieved the JSH 2004 target BP was 51% after 12 months; the percentage was 63% in elderly patients aged ≥65 years without complications, and 43% in patients with concomitant diabetes mellitus or chronic kidney disease. No association was found between a decrease in plasma BNP levels and BP, age, body mass index or estimated glomerular filtration rate. There was a significant increase in serum uric acid and a decrease in serum potassium, but both were within the range of normal values. Adverse events were observed in 8.6% of the patients.
Antihypertensive treatment using two types of drugs (LOS/HCTZ) with different mechanisms yielded potent antihypertensive efficacy with safety and decreased plasma BNP levels.
尽管严格控制血压（BP）可有效预防心血管事件，但在许多高血压患者中往往不够充分。B 型利钠肽（BNP）已被证明与心血管事件有关。我们研究了氯沙坦/氢氯噻嗪联合治疗对基于血管紧张素 II 型 1 型受体拮抗剂（血管紧张素受体阻滞剂 [ARB]）治疗但血压控制不理想的高血压患者的 BP 和血浆 BNP 的影响。
在一项多中心前瞻性观察性研究中，我们招募了 185 名年龄在 36-79 岁（平均年龄 63.8 岁）的原发性高血压但无心力衰竭症状的患者，他们接受基于 ARB 的治疗≥3 个月，但未达到日本高血压学会（JSH）推荐的目标血压。将 ARB 转换为氯沙坦（LOS）50mg/氢氯噻嗪（HCTZ）12.5mg。评估该联合治疗 12 个月的降压疗效、安全性以及对血液生化参数和血浆 BNP 的影响。
治疗 12 个月后，收缩压和舒张压分别从 152±13/87±10mmHg 降至 128±14/74±10mmHg（p<0.001）。平均±标准差血浆 BNP 水平从 46.0±83.0pg/mL 显著下降至 40.8±68.0pg/mL（p<0.05）。治疗 12 个月后，达到 JSH 2004 目标血压的患者比例为 51%；65 岁以上无并发症的老年患者为 63%，合并糖尿病或慢性肾脏病的患者为 43%。血浆 BNP 水平的降低与血压、年龄、体重指数或估算肾小球滤过率之间无相关性。血清尿酸显著升高，血清钾降低，但均在正常值范围内。8.6%的患者出现不良反应。
使用两种作用机制不同的药物（氯沙坦/氢氯噻嗪）进行降压治疗具有良好的降压疗效和安全性，并降低了血浆 BNP 水平。
