Guasti Luigina, Gaudio Giovanni, Lupi Alessandro, D'Avino Marinella, Sala Carla, Mugellini Amedeo, Vulpis Vito, Felis Salvatore, Sarzani Riccardo, Vanasia Massimo, Maffioli Pamela, Derosa Giuseppe
Research Center on Dyslipidemia, Internal Medicine 1, University of Insubria, Varese, Italy.
Internal Medicine Division, Ospedale Angelo Bellini, ASST Valle Olona Somma, Varese, Italy.
Drug Des Devel Ther. 2017 Aug 4;11:2293-2300. doi: 10.2147/DDDT.S134826. eCollection 2017.
Blockade of the renin-angiotensin-aldosterone system is a cornerstone in cardiovascular disease prevention and hypertension treatment. The relevance of ambulatory blood pressure monitoring (ABPM) has been widely confirmed for both increasing the accuracy of blood pressure (BP) measurements, particularly in pharmacological trials, and focusing on 24 h BP prognostic parameters. The aim of this study was to assess the effects of canrenone addition on ambulatory BP in uncontrolled hypertensive patients already treated with the highest tolerated dose of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II type 1 receptor (AT1R) antagonists plus hydrochlorothiazide (HCT).
ABPM was performed at baseline and after 3 months of combination therapy in 158 outpatients with stage 1 or 2 hypertension who were randomized to add canrenone (50 or 100 mg) to the pre-existing therapy with ACE inhibitors or AT1R antagonists plus HCT. Twenty-four-hour systolic and diastolic BPs were considered normalized when the values were <130 and <80 mmHg, respectively.
The addition of canrenone was associated with a reduction in systolic and diastolic BPs (24 h and daytime and nighttime; <0.001), mean arterial pressures (<0.001), and pulse pressures (<0.01). The Δ 24 h systolic/diastolic BPs were -13.5±11.2/-8±8 mmHg and -16.1±13.5/-11.2±8.3 mmHg (50 and 100 mg/day, respectively). In the 50 mg arm, the 24 h systolic and diastolic BPs were normalized in 67.5% and 74% of the patients, respectively, and in 61.6% and 68.5% of the patients in the 100 mg arm, respectively (<0.05; = not significant for 50 vs 100 mg). The percentage of patients whose nocturnal decrease was >10% with respect to diurnal values did not change during combination therapy.
Canrenone addition to ACE inhibitors or AT1R antagonists plus HCT was associated with a significant reduction of 24 h BP and to an increased number of patients meeting 24 h ABPM targets in a clinical setting of uncontrolled stage 1 or 2 hypertension.
肾素-血管紧张素-醛固酮系统阻断是心血管疾病预防和高血压治疗的基石。动态血压监测（ABPM）的相关性已得到广泛证实，它既能提高血压（BP）测量的准确性，尤其是在药物试验中，又能关注24小时血压预后参数。本研究的目的是评估在已接受最大耐受剂量血管紧张素转换酶（ACE）抑制剂或1型血管紧张素II受体（AT1R）拮抗剂加氢氯噻嗪（HCT）治疗的血压控制不佳的高血压患者中添加坎利酮对动态血压的影响。
对158例1或2期高血压门诊患者进行基线和联合治疗3个月后的ABPM，这些患者被随机分组，在已有的ACE抑制剂或AT1R拮抗剂加HCT治疗基础上加用坎利酮（50或100mg）。当收缩压和舒张压分别<130和<80mmHg时，认为24小时收缩压和舒张压正常。
添加坎利酮与收缩压和舒张压降低相关（24小时、白天和夜间；<0.001），平均动脉压降低（<0.001），脉压降低（<0.01）。24小时收缩压/舒张压的变化分别为-13.5±11.2/-8±8mmHg和-16.1±13.5/-11.2±8.3mmHg（分别为50和100mg/天）。在50mg组中，分别有67.5%和74%的患者24小时收缩压和舒张压正常化，在100mg组中分别为61.6%和68.5%的患者（<0.05；50mg与100mg比较无显著差异）。联合治疗期间，夜间血压较日间血压下降>10%的患者百分比未改变。
在1或2期血压控制不佳的高血压临床环境中，在ACE抑制剂或AT1R拮抗剂加HCT基础上加用坎利酮与24小时血压显著降低及达到24小时ABPM目标的患者数量增加相关。
