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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。
Objective To observe the effect of losartan and irbesartan on serum uric acid in essential hypertension patients with hyperuricemia and to evaluate its antihypertensive effects. Methods A multicenter, randomized, double-blind, parallel-controlled design was used. Patients with grade 1 or 2 essential hypertension with hyperuricemia (serum uric acid concentrations ≥90 μmol / L in men and ≥310 μmol / L in women) were randomized to receive either losartan (Systolic blood pressure <140 mm Hg (1 mm Hg = 0.133 kPa) and diastolic blood pressure <90 mm Hg] after 4 weeks of treatment (50 mg / d) or irbesartan (150 mg / d) Continue the original dose of treatment for 4 weeks; such as blood pressure is not controlled [systolic blood pressure ≥ 140 mm Hg and / or diastolic blood pressure ≥ 90 mm Hg], the dose of the drug doubled, continue treatment for 4 weeks, observed serum uric acid concentration and blood pressure changes . Results A total of 351 patients were randomized and 325 patients completed the trial. 162 patients in the losartan group and 163 patients in the irbesartan group. Serum uric acid levels in Losartan group were significantly lower than those in Irbesartan group (P <0.05) after 4 weeks and 8 weeks after treatment, respectively , 8 weeks serum uric acid concentration losartan group was significantly lower than the irbesartan group (P <0.0001). Compared with before treatment, systolic blood pressure and diastolic blood pressure were significantly decreased in both groups at 4 weeks and 8 weeks (P <0.0001). There was no significant difference in systolic and diastolic blood pressure between the two groups (P> 0.05). Conclusion Losartan treatment can significantly reduce the level of serum uric acid in patients with primary hyperuricemia and irbesartan does not significantly reduce serum uric acid; both ARB can effectively control blood pressure. Therefore, losartan is ideal for the treatment of mild to moderate hypertensive patients with hyperuricemia.