Dudenbostel Tanja, Calhoun David A
Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Am J Hypertens. 2017 Feb;30(2):103-109. doi: 10.1093/ajh/hpw105. Epub 2016 Sep 8.
Multiple studies indicate that primary aldosteronism (PA) is common in patients with resistant hypertension, with an estimated prevalence of approximately 20%. Additional studies suggest that beyond this 20% of patients with classical PA, there is a larger proportion of patients with lesser degrees of hyperaldosteronism which contributes even more broadly to antihypertensive treatment resistance. Given these observations, it is intuitive that use of aldosterone antagonists will provide antihypertensive benefit in patients with resistant hypertension and evidence of aldosterone excess. Intriguingly, however, are clinical findings demonstrating substantive benefit of aldosterone antagonists in patients with resistant hypertension, but without demonstrative evidence of hyperaldosteronism, that is, with seemingly normal or even low aldosterone levels.
Spironolactone is clearly established as the most effective fourth agent for treatment of uncontrolled resistant hypertension. Emerging observations suggest a further role of spironolactone for counteracting the effects of diet high in sodium, particularly in obese, hypertensive patients.
多项研究表明，原发性醛固酮增多症（PA）在顽固性高血压患者中很常见，估计患病率约为20%。其他研究表明，除了这20%的典型PA患者外，还有更大比例的醛固酮增多程度较轻的患者，他们对降压治疗抵抗的影响更为广泛。基于这些观察结果，使用醛固酮拮抗剂会给有顽固性高血压且有醛固酮过多证据的患者带来降压益处，这是合乎情理的。然而，有趣的是，临床研究结果显示，醛固酮拮抗剂对顽固性高血压患者有显著益处，但却没有醛固酮增多症的明确证据，即醛固酮水平看似正常甚至偏低。
螺内酯已明确成为治疗难治性高血压最有效的第四种药物。新出现的观察结果表明，螺内酯在抵消高钠饮食影响方面有进一步作用，特别是在肥胖的高血压患者中。
