Saracho R, Martin-Malo A, Martinez I, Aljama P, Montenegro J
Nephrology Service, Hospital de Galdakao, Vizcaya, Spain.
Kidney Int Suppl. 1998 Dec;68:S125-9. doi: 10.1046/j.1523-1755.1998.06825.x.
Angiotensin converting enzyme inhibitors (ACEIs) have been shown to be effective in the treatment of dialysis patients with high blood pressure, however, they also have been associated with anaphylactoid reactions at the start of dialysis, when they have been used concomitantly with AN69 membranes. A multicenter, open six-month study was designed to test the tolerability and efficacy of losartan as antihypertensive in patients under hemodialysis (HD), with particular emphasis on the appearance of anaphylactoid reactions. HD patients with systolic blood pressure (SBP) levels > or = 140 and/or diastolic blood pressure (DBP) > or = 90 mm Hg, previously nontreated, treated but uncontrolled, or treated with a poor tolerability, were included. The study performed three controls: baseline, at month 3, and at study completion. DBP and SBP levels were measured on the six HD sessions previous to the three visits in addition to biochemical and hematology measurements. Four hundred and six patients were included. The mean age was 55 years, 42% were women, and 23.6% of the patients were dialyzed with AN69 membranes. There was a significant reduction in pre- and postdialysis SBP and DBP at three and six months. Fifteen patients discontinued the study due to adverse reactions related to losartan, and in seven of them the adverse reaction was hypotension. Only two patients have reported a possible anaphylactoid reaction on treatment with AN69, in one of them the HD session had to be stopped and losartan was discontinued. On the contrary, nine patients with a history of previous anaphylactoid reaction, with ACEIs and AN69, have not shown this complication with losartan and AN69. We conclude that losartan is a well tolerated antihypertensive by HD patients, with a very low incidence of adverse reactions, and a lower prevalence of anaphylactoid reactions than those detected with ACEIs and AN69.
血管紧张素转换酶抑制剂（ACEIs）已被证明对治疗高血压透析患者有效，然而，当它们与AN69膜同时使用时，在透析开始时也会引发类过敏反应。一项多中心、为期六个月的开放性研究旨在测试氯沙坦在血液透析（HD）患者中作为抗高血压药物的耐受性和疗效，特别关注类过敏反应的出现。纳入了收缩压（SBP）水平≥140和/或舒张压（DBP）≥90 mmHg的HD患者，这些患者此前未接受治疗、接受过治疗但血压未得到控制或对治疗耐受性差。该研究进行了三次对照：基线、第3个月和研究结束时。除了生化和血液学测量外，在三次访视前的六次HD治疗期间测量DBP和SBP水平。共纳入406例患者。平均年龄为55岁，42%为女性，23.6%的患者使用AN69膜进行透析。在三个月和六个月时，透析前和透析后的SBP和DBP均显著降低。15例患者因与氯沙坦相关的不良反应而停止研究，其中7例的不良反应为低血压。只有2例患者报告在使用AN69治疗时可能出现类过敏反应，其中1例患者不得不停止HD治疗并停用氯沙坦。相反，9例既往有使用ACEIs和AN69引发类过敏反应病史的患者，在使用氯沙坦和AN69时未出现这种并发症。我们得出结论，氯沙坦是HD患者耐受性良好的抗高血压药物，不良反应发生率极低，与ACEIs和AN69相比，类过敏反应的发生率更低。
