目的观察血管紧张素Ⅱ受体拮抗剂(ARB)氯沙坦与伊贝沙坦治疗对伴高尿酸血症的原发性高血压患者血清尿酸水平的影响并评价其降压疗效。方法采用多中心、随机、双盲、平行对照设计。伴高尿酸血症(血清尿酸浓度男性≥390μmol/L,女性≥310...目的观察血管紧张素Ⅱ受体拮抗剂(ARB)氯沙坦与伊贝沙坦治疗对伴高尿酸血症的原发性高血压患者血清尿酸水平的影响并评价其降压疗效。方法采用多中心、随机、双盲、平行对照设计。伴高尿酸血症(血清尿酸浓度男性≥390μmol/L,女性≥310μmol/L)的1～2级原发性高血压患者,经2周安慰剂洗脱期后,随机分入氯沙坦组(50 mg/d)或伊贝沙坦组(150 mg/d),治疗4周,如血压得到控制[收缩压<140 mm Hg(1mm Hg=0.133 kPa)和舒张压<90 mm Hg],继续原剂量治疗4周;如血压未得到控制[收缩压≥140 mm Hg 和(或)舒张压≥90 mm Hg],将上述药物剂量加倍,继续治疗4周,观察血清尿酸浓度及血压的变化。结果随机人选351例患者,325例完成试验,氯沙坦组162例,伊贝沙坦组163例。与治疗前比较,氯沙坦组治疗4周末、8周末血清尿酸浓度明显降低(P<0.0001),伊贝沙坦组则无明显降低(P>0.05);两组之间比较,治疗4周、8周血清尿酸浓度氯沙坦组明显低于伊贝沙坦组(P<0.0001)。与治疗前比较,两组治疗4周、8周末收缩压和舒张压均有明显下降(P<0.0001);两组之间比较,治疗4周、8周末收缩压和舒张压差异无统计学意义(P>0.05)。结论氯沙坦治疗能显著降低伴高尿酸血症的原发性高血压患者的血清尿酸水平,伊贝沙坦无明显降低血清尿酸作用;两种 ARB 均能有效控制血压。因此,氯沙坦是治疗伴高尿酸血症的轻中度高血压患者的理想选择。展开更多
We aimed to investigate the effectiveness and safety of angiotensin-converting enzyme inhibitors （ACEIs） or angiotensin Ⅱ receptor blockers （ARBs） on preventing atrial fibrillation in essential hypertensive patie...We aimed to investigate the effectiveness and safety of angiotensin-converting enzyme inhibitors （ACEIs） or angiotensin Ⅱ receptor blockers （ARBs） on preventing atrial fibrillation in essential hypertensive patients. Systematic literature retrieval was carried out to obtain randomized controlled trials on the effects of ACEI/ ARBs on essential hypertensive patients before December, 2013. Data extraction and quality evaluation were performed. Meta-analysis was performed by Review Manager 5.2.3. Ten high quality studies （11 articles） with a total of 42,892 patients （20,491 patients in the ACEI/ARBs group and 22,401 patients in the β-blocker or the calcium antagonist group） met the inclusion criteria and were included in the meta-analysis. The results showed that ACEI/ARBs reduced the incidence of atrial fibrillation （AF） recurrence compared to calcium antagonists （RR=0.48; 95%CI, 0.40-0.58; P〈0.00001） or β-blockers （RR=0.39; 95%CI, 0.20-0.74; P=0.005） in long-term follow-up, respectively. Furthermore, ACEI/ARBs reduced the incidence of conges- tive heart failure （RR=0.86; 95%CI, 0.77-0.96; P=0.007）. However, no significant effects were observed on the incidence of new AF, cardiac death, myocardial infarction, and stroke. Our results suggest that ACEI/ ARBs may reduce the incidence of AF recurrence and congestive heart failure, with fewer serious adverse effects.展开更多
文摘目的观察血管紧张素Ⅱ受体拮抗剂(ARB)氯沙坦与伊贝沙坦治疗对伴高尿酸血症的原发性高血压患者血清尿酸水平的影响并评价其降压疗效。方法采用多中心、随机、双盲、平行对照设计。伴高尿酸血症(血清尿酸浓度男性≥390μmol/L,女性≥310μmol/L)的1～2级原发性高血压患者,经2周安慰剂洗脱期后,随机分入氯沙坦组(50 mg/d)或伊贝沙坦组(150 mg/d),治疗4周,如血压得到控制[收缩压<140 mm Hg(1mm Hg=0.133 kPa)和舒张压<90 mm Hg],继续原剂量治疗4周;如血压未得到控制[收缩压≥140 mm Hg 和(或)舒张压≥90 mm Hg],将上述药物剂量加倍,继续治疗4周,观察血清尿酸浓度及血压的变化。结果随机人选351例患者,325例完成试验,氯沙坦组162例,伊贝沙坦组163例。与治疗前比较,氯沙坦组治疗4周末、8周末血清尿酸浓度明显降低(P<0.0001),伊贝沙坦组则无明显降低(P>0.05);两组之间比较,治疗4周、8周血清尿酸浓度氯沙坦组明显低于伊贝沙坦组(P<0.0001)。与治疗前比较,两组治疗4周、8周末收缩压和舒张压均有明显下降(P<0.0001);两组之间比较,治疗4周、8周末收缩压和舒张压差异无统计学意义(P>0.05)。结论氯沙坦治疗能显著降低伴高尿酸血症的原发性高血压患者的血清尿酸水平,伊贝沙坦无明显降低血清尿酸作用;两种 ARB 均能有效控制血压。因此,氯沙坦是治疗伴高尿酸血症的轻中度高血压患者的理想选择。
文摘目的 了解维持性血液透析（血透）患者高血压的患病和治疗情况,为血透患者的高血压诊断和治疗提供依据.方法 对上海市11家透析中心的1382例维持性血透患者进行横断面调查,其中男性809例,女性573例.结果 （1）本次受访的维持性血透患者高血压患病率为86.3%,治疗率96.8%,控制率[血透前血压＜140/90 mm Hg（1 mm Hg=0.133 kPa）]25.5%;（2）50.4%患者应用一种降压药,应用2、3和4种或以上者占34.4%、14.2%和1.0%.单药用药以钙通道阻滞剂为多（61.0%）,血管紧张素Ⅱ受体拮抗剂和血管紧张素转换酶抑制剂分别为56.4%和6.4%,中枢性降压药物为26.4%,β或α、β阻滞剂为14.0%.联合用药以钙通道阻滞剂联合血管紧张素Ⅱ受体拮抗剂最常用（63.2%）;（3）冠心病、透析充分性和用药数量影响血透患者的高血压控制率,冠心病以及联合用药者高血压控制更困难,而充分透析有助于提高高血压控制率.结论 维持性血透患者中高血压极为常见,患病率和治疗率均较高,但控制率很低,降压药物的联合应用不够.维持性血透患者的血压控制情况受透析充分性、心脏疾病、降压药物使用情况等多种因素影响.
基金supported by grants from the National Natural Science Foundation of China(No.81270255 to L-SW)
文摘We aimed to investigate the effectiveness and safety of angiotensin-converting enzyme inhibitors （ACEIs） or angiotensin Ⅱ receptor blockers （ARBs） on preventing atrial fibrillation in essential hypertensive patients. Systematic literature retrieval was carried out to obtain randomized controlled trials on the effects of ACEI/ ARBs on essential hypertensive patients before December, 2013. Data extraction and quality evaluation were performed. Meta-analysis was performed by Review Manager 5.2.3. Ten high quality studies （11 articles） with a total of 42,892 patients （20,491 patients in the ACEI/ARBs group and 22,401 patients in the β-blocker or the calcium antagonist group） met the inclusion criteria and were included in the meta-analysis. The results showed that ACEI/ARBs reduced the incidence of atrial fibrillation （AF） recurrence compared to calcium antagonists （RR=0.48; 95%CI, 0.40-0.58; P〈0.00001） or β-blockers （RR=0.39; 95%CI, 0.20-0.74; P=0.005） in long-term follow-up, respectively. Furthermore, ACEI/ARBs reduced the incidence of conges- tive heart failure （RR=0.86; 95%CI, 0.77-0.96; P=0.007）. However, no significant effects were observed on the incidence of new AF, cardiac death, myocardial infarction, and stroke. Our results suggest that ACEI/ ARBs may reduce the incidence of AF recurrence and congestive heart failure, with fewer serious adverse effects.
