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Reserpine Substantially Lowers Blood Pressure in Patients with Refractory Hypertension: A Proof of Concept Study.

利血平大幅降低难治性高血压患者的血压: 一项概念验证研究。

  • 影响因子:2.49
  • DOI:10.1093/ajh/hpaa042
  • 作者列表:"Siddiqui M","Bhatt H","Judd EK","Oparil S","Calhoun DA
  • 发表时间:2020-03-17
Abstract

BACKGROUND:Refractory hypertension (RfHTN), a phenotype of antihypertensive treatment failure, is defined as uncontrolled automated office BP [AOBP] ≥130/80 mmHg and awake ambulatory BP [ABP] ≥130/80 mmHg on ≥5 antihypertensive medications, including chlorthalidone and a mineralocorticoid receptor antagonist. Previous studies suggest that RfHTN is attributable to heightened sympathetic tone. The current study tested whether reserpine, a potent sympatholytic agent, lowers BP in patients with RfHTN. METHODS:Twenty-one out of 45 consecutive patients with suspected RfHTN were determined to be fully adherent with their antihypertensive regimen. Seven patients agreed to participate in the current clinical trial with reserpine and six patients completed the study. Other sympatholytic medications, such as clonidine or guanfacine were tapered and discontinued before starting reserpine. Reserpine 0.1 mg daily was administered in an open-label fashion for 4 weeks. All patients were evaluated by AOBP and 24-hour ABP at baseline and after 4 weeks of treatment. RESULTS:Reserpine lowered mean systolic and diastolic AOBP by 29.3±22.2 and 22.0±15.8 mmHg, respectively. Mean 24-hr systolic and diastolic ABP was reduced by 21.8±13.4 and 15.3±9.6 mmHg, mean awake systolic diastolic ABP by 23.8±11.8 and 17.8±9.2 mmHg, and mean asleep systolic and diastolic ABP by 21.5±11.4 and 13.7±6.4 mmHg, respectively. CONCLUSIONS:Reserpine, a potent sympatholytic agent, lowers BP in patients whose BP remained uncontrolled on maximal antihypertensive therapy, lending support to the hypothesis that excess sympathetic output contributes importantly to the development of RfHTN.

摘要

背景: 难治性高血压 (RfHTN),一种降压治疗失败的表型,定义为在 ≥ 5 种抗高血压药物 (包括氯噻酮和一种盐皮质激素受体拮抗剂) 下,不受控制的自动化 office BP [AOBP] ≥ 130/80 mmHg 和清醒的非卧床 BP [ABP] ≥ 130/80 mmHg。既往研究表明,RfHTN 可归因于交感神经张力增强。目前的研究测试了利血平,一种有效的交感神经溶解剂,是否能降低 RfHTN 患者的血压。 方法: 在 45 例疑似 RfHTN 的连续患者中,有 21 例被确定为完全符合其降压方案。7 名患者同意参加利血平目前的临床试验,6 名患者完成了研究。其他交感神经药物,如可乐定或胍法辛,在开始利血平前逐渐减量并停药。利血平 0.1 mg 每日以开放标签方式给药 4 周。所有患者在基线和治疗 4 周后通过 AOBP 和 24 小时 ABP 进行评价。 结果: 利血平使平均收缩期和舒张期 AOBP 分别降低 29.3 ± 22.2 和 22.0 ± 15.8 mmHg。平均 24 h 收缩期和舒张期 ABP 分别降低 21.8 ± 13.4 和 15.3 ± 9.6 mmHg,平均清醒收缩期舒张期 ABP 分别降低 23.8 ± 11.8 和 17.8 ± 9.2 mmHg,平均睡眠收缩和舒张 ABP 分别为 21.5 ± 11.4 和 13.7 ± 6.4 mmHg。 结论: 利血平是一种有效的交感神经溶解剂,在最大限度降压治疗时,利血平可降低血压仍然不受控制的患者的血压,支持交感神经输出过多对 RfHTN 发生有重要影响的假设。

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