氨氯地平的治疗药物监测及Z-FHL/HHL比值：针对明显难治性高血压患者的依从性工具

Therapeutic drug monitoring of amlodipine and the Z-FHL/HHL ratio: Adherence tools in patients referred for apparent treatment-resistant hypertension.

作者信息

Jones E S W, Lesosky M, Blockman M, Castel S, Decloedt E H, Schwager S L U, Sturrock E D, Wiesner L, Rayner B L

机构信息

Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa.

出版信息

S Afr Med J. 2017 Sep 22;107(10):887-891. doi: 10.7196/SAMJ.2017.v107i10.12268.

DOI:10.7196/SAMJ.2017.v107i10.12268

PMID:29022534

Abstract

BACKGROUND

Non-adherence to antihypertensives is a cause of 'pseudo-treatment-resistant' hypertension.

OBJECTIVE

To determine whether monitoring plasma amlodipine concentrations and inhibition of angiotensin-converting enzyme (ACE) can be adjunct adherence tools.

METHODS

Patients with hypertension who were prescribed enalapril and amlodipine were enrolled. Blood pressures (BPs) were monitored and an adherence questionnaire was completed. Steady-state amlodipine was assayed using liquid chromatography-mass spectrometry and degree of ACE inhibition using the Z-FHL/HHL (z-phenylalanine-histidine-leucine/hippuryl-histidine-leucine) ratio.

RESULTS

One hundred patients (mean (standard deviation) age 50.5 (12) years, 46% male) were enrolled. Based on plasma assays, 26/97 patients (26.8%) were unsuppressed by enalapril and 20/100 (20%) were sub-therapeutic for amlodipine. There were significant BP differences based on plasma levels of the medication: 21/20 mmHg lower in the group with suppressed ACE and 26/20 mmHg in the group with steady-state amlodipine concentrations.

CONCLUSIONS

Monitoring antihypertensive adherence by assaying plasma medication concentrations is a feasible option for evaluating true v. pseudo-resistant hypertension.

摘要

背景

不坚持服用抗高血压药物是“假性难治性”高血压的一个原因。

目的

确定监测血浆氨氯地平浓度和抑制血管紧张素转换酶（ACE）是否可作为辅助的依从性工具。

方法

纳入接受依那普利和氨氯地平治疗的高血压患者。监测血压（BP）并完成一份依从性调查问卷。使用液相色谱 - 质谱法测定氨氯地平稳态浓度，使用Z - FHL/HHL（z - 苯丙氨酸 - 组氨酸 - 亮氨酸/马尿酰 - 组氨酸 - 亮氨酸）比值测定ACE抑制程度。

结果

共纳入100例患者（平均（标准差）年龄50.5（12）岁，46%为男性）。根据血浆检测，26/97例患者（26.8%）依那普利未发挥抑制作用，20/100例患者（20%）氨氯地平治疗效果欠佳。根据药物血浆水平存在显著的血压差异：ACE受抑制组血压低21/20 mmHg，氨氯地平稳态浓度组血压低26/20 mmHg。