Adachi Hisashi, Kakuma Tatsuyuki, Kawaguchi Machiko, Kumagai Eita, Fukumoto Yoshihiro
Department of Community Medicine, Kurume University School of Medicine.
Division of Cardio-Vascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan.
Medicine (Baltimore). 2019 Apr;98(15):e14994. doi: 10.1097/MD.0000000000014994.
The impact of aldosterone blockade using eplerenone on hypertensives with obesity has not been clarified. We compared the efficacy and safety between eplerenone and trichlormethiazide in hypertensives with overweight or obesity.
A prospective, randomized, open-labeled, blinded-endpoint design, multicenter trial enrolled 204 hypertension-treated outpatients with obesity [body mass index (BMI) ≥25 kg/m] evaluated by ambulatory blood pressure (BP) measurement. Patients were randomly assigned to receive 50 mg of eplerenone (n = 102) or 1 mg of trichlormethiazide (n = 102), each of which were administered once every morning. Primary efficacy endpoints were systolic and diastolic BPs and biomarkers of glucose metabolism after 6 months of treatment.
At baseline, BPs were comparable between the two groups. Systolic/diastolic blood pressure (SBP/DBP) were reduced from 153.9 ± 12.6/84.6 ± 11.8 to 129.8 ± 14.2/73.7 ± 12.2 mm Hg by eplerenone therapy and from 152.2 ± 12.5/85.2 ± 10.9 to 133.8 ± 12.6/76.1 ± 8.6 mm Hg by trichlormethiazide therapy (all; P < .001). The efficacy of SBP reduction after adjustment for age, sex, and BMI was significantly greater in the eplerenone group than the trichlormethiazide (P = .034), although the efficacy of DBP reduction was marginally significant (P = .072). Especially, the efficacy of BP reduction was more effective for aged over 65 years than less than 65 years. However, biomarkers of glucose metabolism were not significantly different between these 2 groups.
The eplerenone therapy was more effective in BP lowering in hypertensives with overweight or obesity than the trichlormethiazide therapy, especially in the elderly.
依普利酮阻断醛固酮对肥胖高血压患者的影响尚未明确。我们比较了依普利酮和三氯噻嗪在超重或肥胖高血压患者中的疗效和安全性。
一项前瞻性、随机、开放标签、盲终点设计的多中心试验纳入了204例通过动态血压测量评估的肥胖高血压门诊患者[体重指数（BMI）≥25kg/m²]。患者被随机分配接受50mg依普利酮（n = 102）或1mg三氯噻嗪（n = 102），均每天早晨服用一次。主要疗效终点是治疗6个月后的收缩压和舒张压以及糖代谢生物标志物。
基线时，两组血压相当。依普利酮治疗使收缩压/舒张压（SBP/DBP）从153.9±12.6/84.6±11.8降至129.8±14.2/73.7±12.2mmHg，三氯噻嗪治疗使其从152.2±12.5/85.2±10.9降至133.8±12.6/76.1±8.6mmHg（均P <.001）。在调整年龄、性别和BMI后，依普利酮组收缩压降低的疗效显著高于三氯噻嗪组（P = 0.034），尽管舒张压降低的疗效差异无统计学意义（P = 0.072）。特别是，65岁以上患者的血压降低疗效比65岁以下患者更显著。然而，两组之间糖代谢生物标志物无显著差异。
依普利酮治疗在超重或肥胖高血压患者中降低血压的效果比三氯噻嗪治疗更显著，尤其是在老年人中。
