依普利酮对老年原发性醛固酮增多症患者的降压作用
Antihypertensive Effects of Esaxerenone in Older Patients with Primary Aldosteronism.
作者信息
Fujimoto Masanori, Watanabe Suzuka, Igarashi Katsushi, Ruike Yutaro, Ishiwata Kazuki, Naito Kumiko, Ishida Akiko, Koshizaka Masaya, Suzuki Sawako, Shiko Yuki, Koide Hisashi, Yokote Koutaro
机构信息
Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan.
Department of Diabetes, Endocrinology and Metabolism, Chiba University Hospital, Chiba 260-8670, Japan.
出版信息
Int J Hypertens. 2023 Jan 17;2023:6453933. doi: 10.1155/2023/6453933. eCollection 2023.
DESIGN
Retrospective cohort study. . The data was obtained from a total of 87 PA patients treated with esaxerenone. The treatment group comprised 33 patients who received esaxerenone as first-line therapy and 54 patients that switched from another MRA to esaxerenone. . Blood pressure (BP), plasma aldosterone concentration (PAC), plasma renin activity (PRA), serum potassium level, estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (UACR), and brain natriuretic peptide (BNP) were assessed before and after treatment with esaxerenone. Patients with overall reductions in their systolic or diastolic BP by 10 mmHg, or more, were considered responders. Unpaired -tests of the biochemical and personal parameters between responders and nonresponders were run to find the most influencing characteristic for treatment success.
RESULTS
BP overall decreased after treatment with esaxerenone (systolic BP: =0.025, diastolic BP: =0.096). Serum potassium levels increased, while eGFR decreased (=0.047 and 0.043, respectively). No patients needed a dose reduction or treatment discontinuation of esaxerenone based on the serum potassium and eGFR criteria. UACR and BNP decreased insignificantly. The responders were significantly older than the nonresponders of the esaxerenone treatment (=0.0035).
CONCLUSIONS
Esaxerenone was effective in older patients with primary aldosteronism.
设计
回顾性队列研究。数据来自总共87例接受依普利酮治疗的原发性醛固酮增多症（PA）患者。治疗组包括33例接受依普利酮作为一线治疗的患者和54例从其他盐皮质激素受体拮抗剂（MRA）转换为依普利酮的患者。在依普利酮治疗前后评估血压（BP）、血浆醛固酮浓度（PAC）、血浆肾素活性（PRA）、血清钾水平、估算肾小球滤过率（eGFR）、尿白蛋白肌酐比值（UACR）和脑钠肽（BNP）。收缩压或舒张压总体降低10 mmHg或更多的患者被视为反应者。对反应者和无反应者之间的生化和个人参数进行非配对t检验，以找出对治疗成功影响最大的特征。
结果
依普利酮治疗后血压总体下降（收缩压：P = 0.025，舒张压：P = 0.096）。血清钾水平升高，而eGFR降低（分别为P = 0.047和0.043）。根据血清钾和eGFR标准，没有患者需要减少依普利酮剂量或停止治疗。UACR和BNP无明显下降。依普利酮治疗的反应者明显比无反应者年龄大（P = 0.0035）。
结论
依普利酮对老年原发性醛固酮增多症患者有效。
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