Hypertension:螺内酯与可乐定对顽固性高血压的疗效哪个更好?

2018-02-23 MedSci MedSci原创

近期,一项发表在杂志Hypertension上的研究旨在多中心随机试验中的顽固性高血压患者中比较作为第四种药物——螺内酯和可乐定。此项研究通过药丸计数检查药物治疗的依从性。患有顽固性高血压的受试者(非办公室和动态血压[BP]监测对照,使用3种药物(包括利尿剂)治疗12周)被随机分配到螺内酯治疗组(12.5-50mg QD)或可乐定治疗组(0.1-0.3mg BID),进行为期12周的治疗。主要终点

近期,一项发表在杂志Hypertension上的研究旨在多中心随机试验中的顽固性高血压患者中比较作为第四种药物——螺内酯和可乐定。此项研究通过药丸计数检查药物治疗的依从性。

患有顽固性高血压的受试者(非办公室和动态血压[BP]监测对照,使用3种药物(包括利尿剂)治疗12周)被随机分配到螺内酯治疗组(12.5-50mg QD)或可乐定治疗组(0.1-0.3mg BID),进行为期12周的治疗。主要终点是在办公室(<140/90 mmHg)和24小时动态血压(<130/80 mmHg)的血压监测期间的对血压的控制。次要终点包括每种方法的血压控制和血压的绝对降低情况。

最终,从招募的1597名患者中,11.7%(187名患者)的患者符合顽固性高血压标准。与螺内酯组(n = 95)相比,可乐定组(92例)的主要终点达到了相似的比率(分别为20.5%和20.8%;相对危险度为1.01 [0.55-1.88]; P = 1.00 )。

次要终点分析显示,螺内酯和可乐定的办公室血压控制分别为33.3%和29.3%,动态血压监测显示分别为44%和46.2%。然而,螺内酯对24小时收缩压和舒张压以及舒张日间动态血压的下降作用大于可乐定。研究分析结果(限于≥80%坚持螺内酯/可乐定治疗的患者)显示了与主要终点相似的结果。

此项研究结果表明:可乐定在顽固性高血压患者中并不优于螺内酯,总体控制率很低(≈21%)。考虑到次要终点和次要终点减少,螺内酯是第四种控制血压药物治疗的首选。

原始出处:
Krieger EM, Drager LF, et al. Spironolactone Versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension: The ReHOT Randomized Study (Resistant Hypertension Optimal Treatment). Hypertension. 2018 Feb 20. pii: HYPERTENSIONAHA.117.10662. doi: 10.1161/HYPERTENSIONAHA.117.10662.

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    2018-02-25 by2014
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    2018-02-23 wzb521zf

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低钾血症在腹膜透析(PD)患者中是常见的并发症之一,并且其与心血管和全因死亡率增加有关。这类患者的管理方法通常包括安体舒通药物的应用。近期,一项发表在杂志Plos One上的研究评估了螺内酯治疗PD患者低钾血症的疗效。研究者们在单中心的PD患者中进行了回顾性图表分析。比较螺内酯开始治疗前和治疗两个月后,患者血钾的变化情况。此外,还记录了螺内酯的使用情况以及血压(BP)、体重和血清肌酸酐的变化。最终

螺内酯,还可以治疗这些皮肤病?!

1、痤疮青春期性腺发育成熟,体内雄激素水平增高,促使皮脂腺增生肥大,分泌过多的皮脂,刺激毛囊口并产生游离脂肪酸,使毛囊口发生角化栓塞,是本病发生主要的原因。安体舒通通过直接对抗雄激素中活性最强的二氢睾丸酮与皮肤靶器官结合,从而抑制皮脂腺的生长和皮脂的分泌,同时能降低皮肤表面游离脂肪酸,减少皮肤表面的细菌。用安体舒通20毫克,1日3次,连续口服45天为1个疗程,治疗重症痤疮32例,大多在用药后半个月

JAMA Cardiol:心衰急性期该使用大剂量螺内酯吗?

对于急性心衰,指南推荐使用螺内酯,但在急性期时是该使用大剂量,还是小剂量螺内酯呢?美国进行了一项双盲对照研究,共有22家医院参与。结果发现,尽管患者对大剂量螺内酯耐受性良好,但与常规剂量螺内酯相比,并没有更大的获益。

难治性高血压怎么办?指南给你出招!

高血压史导致心脑血管疾病和全因死亡率的主要病因。并且也是健康支出的主要影响因素。有65%的难治性高血压患者认为较高的血压水平是最严重的健康威胁。目前高血压的治疗难点主要为:假性耐药性高血压(5-20%)、耐药性高血压(2-5%)、二级高血压(3-5%)以及服用三种以上降压药物控制的高血压。