Derosa Giuseppe, Gaudio Giovanni, Pasini Gianfranco, D'Angelo Angela, Maffioli Pamela
Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico S Matteo, Pavia, Italy,
Center for the Study of Endocrine-Metabolic Pathophysiology and Clinical Research, University of Pavia, Pavia, Italy,
Drug Des Devel Ther. 2018 Aug 24;12:2611-2616. doi: 10.2147/DDDT.S151449. eCollection 2018.
The aim of this study was to evaluate the effects of canrenone compared to hydrochlorothiazide (HCTZ) added to angiotensin II receptor blockers (ARBs) on glycemia, lipid profile, potassium, aldosterone and renal function in patients with hypertension and type 2 diabetes mellitus.
The study enrolled 182 Caucasian patients with hypertension and type 2 diabetes mellitus. Patients were already taking ARBs and were randomized to canrenone, 50 mg once a day, or HCTZ, 12.5 mg once a day for 1 month. After the first month, patients not reaching an adequate blood pressure (BP) were up-titrated to canrenone 100 mg or HCTZ 25 mg once a day for 12 months. The following parameters were considered at 6 and 12 months: BP, body weight, body mass index (BMI), fasting plasma glucose (FPG), post-prandial glucose (PPG), fasting plasma insulin (FPI), homeostasis model assessment insulin (HOMA-IR), lipid profile, potassium, plasma aldosterone, urine albumin excretion rate and estimated glomerular filtration rate (eGFR).
We observed a similar decrease in BP with both treatments. Canrenone led to a significant decrease in FPG, PPG and HOMA index compared to baseline, while there was a significant increase in the same parameters with HCTZ. HCTZ also worsened glycated hemoglobin (HbA), while canrenone did not change it. No variations in lipid profile were recorded with canrenone, while there was a worsening of total cholesterol (TC) and triglycerides (Tg) with HCTZ. Potassium levels were decreased and uric acid levels were increased by HCTZ, but not by canrenone that had a neutral effect on these parameters. We recorded a slight decrease in eGFR with HCTZ and an improvement with canrenone; creatinine and eGFR were improved by canrenone compared to HCTZ. Plasma aldosterone levels were decreased by canrenone and increased by HCTZ.
Canrenone and HCTZ have a similar effect on BP; however, canrenone seems to improve metabolic parameters, while HCTZ worsens them.
本研究旨在评估与添加到血管紧张素 II 受体阻滞剂（ARB）中的氢氯噻嗪（HCTZ）相比，坎利酮对高血压合并 2 型糖尿病患者血糖、血脂、钾、醛固酮及肾功能的影响。
本研究纳入了 182 例患有高血压和 2 型糖尿病的白种人患者。这些患者已在服用 ARB，并被随机分为两组，一组服用坎利酮，每日 1 次，每次 50 毫克；另一组服用氢氯噻嗪，每日 1 次，每次 12.5 毫克，为期 1 个月。在第一个月后，血压未达标的患者将坎利酮剂量上调至每日 1 次，每次 100 毫克，或将氢氯噻嗪剂量上调至每日 1 次，每次 25 毫克，持续 12 个月。在第 6 个月和第 12 个月时评估以下参数：血压、体重、体重指数（BMI）、空腹血糖（FPG）、餐后血糖（PPG）、空腹血浆胰岛素（FPI）、稳态模型评估胰岛素抵抗指数（HOMA-IR）、血脂、钾、血浆醛固酮、尿白蛋白排泄率和估算肾小球滤过率（eGFR）。
我们观察到两种治疗方法使血压下降程度相似。与基线相比，坎利酮使 FPG、PPG 和 HOMA 指数显著降低，而氢氯噻嗪使这些参数显著升高。氢氯噻嗪还使糖化血红蛋白（HbA）恶化，而坎利酮未使其改变。坎利酮治疗后血脂无变化，而氢氯噻嗪使总胆固醇（TC）和甘油三酯（Tg）恶化。氢氯噻嗪使钾水平降低、尿酸水平升高，而坎利酮对这些参数无影响。我们记录到氢氯噻嗪使 eGFR 略有下降，而坎利酮使其改善；与氢氯噻嗪相比，坎利酮使肌酐和 eGFR 得到改善。坎利酮使血浆醛固酮水平降低，氢氯噻嗪使其升高。
坎利酮和氢氯噻嗪对血压有相似的影响；然而，坎利酮似乎能改善代谢参数，而氢氯噻嗪则使其恶化。
