Schneider Andreas, Schwab Johannes, Karg Marina V, Kalizki Tatjana, Reinold Annemarie, Schneider Markus P, Schmieder Roland E, Schmidt Bernhard M W
aDepartment of Internal Medicine I, Divisions of Nephrology and Intensive Care, University Hospital Würzburg and Comprehensive Heart Failure Center, Würzburg bDepartment of Nephrology and Hypertension, Friedrich-Alexander-University, Erlangen-Nürnberg cInstitute of Radiology and Neuroradiology dDepartment of Cardiology, Paracelsus Medical University, General Hospital Nürnberg, Nürnberg eDepartment of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.
J Hypertens. 2017 May;35(5):1086-1092. doi: 10.1097/HJH.0000000000001264.
Mineralocorticoid receptor antagonists are increasingly used in patients with treatment-resistant hypertension (TRH). There is experimental evidence for blood pressure (BP) independent effects of mineralocorticoid receptor blockade on cardiovascular target organ damage. We hypothesized that low-dose eplerenone (50 mg) will reduce left ventricular mass (LVM) beyond its BP-lowering effects.
We performed a randomized, double-blind, placebo-controlled, parallel group study in 51 patients with TRH. Patients were allocated to receive either eplerenone 50 mg or placebo for 6 months, while other antihypertensive agents could be added in both groups to achieve a BP target of less than 140/90 mmHg. LVM was assessed by MRI before and after treatment.
Baseline office BP was similar in the eplerenone and the placebo group (166 ± 21/91 ± 15 versus 159 ± 19/94 ± 8 mmHg, n.s.). BP was similarly reduced in the eplerenone versus the placebo group (-35 ± 20/-15 ± 11 versus -30 ± 19/-13 ± 7 mmHg, n.s.). However, LVM was reduced only in the eplerenone group (from 155 ± 33 to 136 ± 33 g, P < 0.001), but not in the placebo group (152 ± 32 versus 148 ± 38 g, P = 0.45).
Despite similar BP-lowering, only patients with TRH who were allocated to eplerenone experienced a reduction of LVM. Thus, our data suggest that in patients with TRH, mineralocorticoid receptor antagonists should be used preferentially in order to achieve an effective reduction of LVM along with the improvement of BP control.
盐皮质激素受体拮抗剂在难治性高血压（TRH）患者中的应用越来越广泛。有实验证据表明，盐皮质激素受体阻断对心血管靶器官损害具有独立于血压（BP）的作用。我们假设低剂量依普利酮（50毫克）在降低血压之外还能减轻左心室质量（LVM）。
我们对51例TRH患者进行了一项随机、双盲、安慰剂对照的平行组研究。患者被分配接受50毫克依普利酮或安慰剂治疗6个月，同时两组均可添加其他抗高血压药物，以使血压目标达到低于140/90毫米汞柱。治疗前后通过MRI评估LVM。
依普利酮组和安慰剂组的基线诊室血压相似（166±21/91±15与159±19/94±8毫米汞柱，无显著差异）。依普利酮组与安慰剂组的血压下降程度相似（-35±20/-15±11与-30±19/-13±7毫米汞柱，无显著差异）。然而，仅依普利酮组的LVM降低（从155±33克降至136±33克，P<0.001），而安慰剂组未降低（152±32与148±38克，P=0.45）。
尽管降压效果相似，但只有分配接受依普利酮治疗的TRH患者的LVM有所降低。因此，我们的数据表明，在TRH患者中，应优先使用盐皮质激素受体拮抗剂，以便在改善血压控制的同时有效降低LVM。
