Griffing G T, Sindler B H, Aurecchia S A, Melby J C
Metabolism. 1983 Jul;32(7):711-6. doi: 10.1016/0026-0495(83)90129-4.
The study reported here prospectively evaluated the prevention of diuretic-induced secondary hyperaldosteronism and hypokalemia by a converting enzyme inhibitor, enalapril (MK 421). Eighteen normal subjects were randomized into three groups: (1) a HCTZ group (hydrochlorothiazide (HCTZ) 50 mg/day); (2) a MK-421 group (MK-421 10 mg/day); and (3) a HCTZ + MK-421 group [HCTZ 50 mg/day plus MK-421 10 mg/day]. Following a five-day control and a 28-day treatment period, the HCTZ group demonstrated an attenuated but persistent secondary hyperaldosteronism and hypokalemia, the MK-421 group manifested a gradual decline in aldosterone secretion, and the HCTZ + MK-421 group had a delayed but effective correction of secondary hyperaldosteronism and hypokalemia at 28 days but not before. In conclusion, MK-421 reversed diuretic-induced secondary hyperaldosteronism and hypokalemia after 28 days of hydrochlorothiazide therapy. Therefore, converting enzyme inhibitors, such as enalapril, provide useful adjunctive therapy in diuretic-treated patients, but potassium supplementation may be required before the start of four weeks of combined therapy.
本研究前瞻性评估了转换酶抑制剂依那普利（MK 421）对利尿剂诱发的继发性醛固酮增多症和低钾血症的预防作用。18名正常受试者被随机分为三组：（1）氢氯噻嗪组（氢氯噻嗪（HCTZ）50毫克/天）；（2）MK - 421组（MK - 421 10毫克/天）；（3）氢氯噻嗪 + MK - 421组[氢氯噻嗪50毫克/天加MK - 421 10毫克/天]。经过为期5天的对照期和28天的治疗期后，氢氯噻嗪组表现出继发性醛固酮增多症和低钾血症虽有所减轻但仍持续存在，MK - 421组醛固酮分泌逐渐下降，氢氯噻嗪 + MK - 421组在28天时继发性醛固酮增多症和低钾血症得到延迟但有效的纠正，但在此之前未得到纠正。总之，在氢氯噻嗪治疗28天后，MK - 421逆转了利尿剂诱发的继发性醛固酮增多症和低钾血症。因此，转换酶抑制剂，如依那普利，在接受利尿剂治疗的患者中提供了有用的辅助治疗，但在联合治疗四周开始前可能需要补充钾。
