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目的探讨氢氯噻嗪(HCTZ)与卡托普利长期联合治疗对高血压患者肾素-血管紧张素-醛固酮系统(RAAS)活性及生化指标的影响。方法在9所开滦矿区医院筛选出轻、中度高血压患者,在2周洗脱期和6周HCTZ(12.5mg,1次/d)导入期后加服卡托普利(25mg,2次/d),治疗5a。于洗脱期末、导入期末、治疗2a和5a时检测RAAS活性,每年检测血生化指标,比较各时间点RAAS活性变化与生化指标变化。结果6周HCTZ导入期末,患者血浆血管紧张素Ⅱ(AngⅡ)和醛固酮(ALD)浓度较基线值升高,差别有统计学意义(P<0.01),血钠浓度下降(P<0.01);治疗2a时血浆AngⅡ、ALD和血钠浓度已恢复至基线水平,血糖浓度下降(P<0.01);治疗5a后,血钾浓度下降(P<0.01),而血糖、血钠、AngⅡ、ALD浓度变化与基线值比较,差别无统计学意义(P>0.05)。结论高血压患者长期合用HCTZ与卡托普利治疗后,RAAS活性可恢复至治疗前水平,对血糖浓度影响不大,而血钾降低。
Objective To investigate the effects of long-term combination of hydrochlorothiazide (HCTZ) and captopril on the activity and biochemical parameters of renin-angiotensin-aldosterone system (RAAS) in patients with essential hypertension. Methods Nine patients with mild to moderate hypertension were screened out in 9 hospitals of Kailuan Mining District. After 2 weeks of elution and 6 weeks of introduction of HCTZ (12.5mg, 1 / d), captopril (25mg, 2 Times / d), treatment 5a. At the end of the elution period, the RAAS activity was detected at the end of the induction period and at the time of 2a and 5a treatment. Blood biochemical indexes were measured every year. The changes of RAAS activity and biochemical indexes were compared at different time points. Results At the end of 6 weeks of HCTZ induction, the levels of plasma angiotensin Ⅱ (ALD) and aldosterone (ALD) were significantly higher than those of the baseline (P <0.01), and the serum sodium concentration was decreased (P <0.01) The levels of plasma AngⅡ, ALD and serum sodium had been restored to the baseline level at 2 years (P <0.01), and the blood glucose levels decreased (P <0.01) Compared with the baseline value, the difference was not statistically significant (P> 0.05). Conclusion After long-term treatment with HCTZ and captopril in hypertensive patients, the activity of RAAS can be restored to the pre-treatment level, with little effect on blood glucose concentration and decreased serum potassium.