对难治性高血压降压方案若干思考.pptVIP

Addition of Spironolactone in Patients With Resistant Arterial Hypertension (ASPIRANT) Median no. of antihypertensives: 4 (3; 6) Office SBP: 154.9 (±10.4) 153.5 (±12.0) Office DBP: 92.6 (±10.7) 90.6 (±10.9) 24-h ABPM SBP, mm Hg 143.1 (±13.5) 139.8 (±16.4) 24-h ABPM DBP, mm Hg 81.1 (±10.2) 79.3 (±10.2) Hypertension. 2011; 57: 1069-1075 randomized, double-blind, placebo-controlled trial 分别接受螺内酯25 mg/d或安慰剂 治疗8周 ASPIRANT: Hypertension. 2011; 57: 1069-1075 血醛固酮/肾素比值较高(ARR7）或肾素活性较低（PRA ≤1.34 ng/mL）时，螺内酯的降压作用较大。单看血醛固酮，则对螺内酯的降压作用无显著影响 可考虑的联合降压方案 肼苯哒嗪＋高剂量β受体阻断剂 ＋袢利尿剂 降压效果增强