Effects of spironolactone and angiotensin-converting enzyme inhibitor on left ventricular hypertrophy in patients with essential hypertension

被引:58
作者
Sato, A
Suzuki, Y
Saruta, T
机构
[1] Mito Red Cross Hosp, Dept Internal Med, Mito, Ibaraki 3100011, Japan
[2] Keio Univ, Dept Internal Med, Tokyo, Japan
来源
HYPERTENSION RESEARCH-CLINICAL AND EXPERIMENTAL | 1999年 / 22卷 / 01期
关键词
aldosterone; left ventricular hypertrophy; essential hypertension; spironolactone; ACE inhibitor;
D O I
10.1291/hypres.22.17
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
There is increasing evidence for important cardiovascular effects of aldosterone via classical mineralocorticoid receptors in the heart. Administration of aldosterone with excess salt produces both cardiac hypertrophy and interstitial cardiac fibrosis in rats, and concomitant administration of potassium canrenoate at a dose that only modestly lowers blood pressure completely blocks the cardiac effects of aldosterone, In the present study, we examined the effect on left ventricular hypertrophy of adding a low dose of the mineralocorticoid receptor antagonist spironolactone (25 mg/d) to an angiotensin-converting enzyme inhibitor (enalapril maleate) in patients with essential hypertension. Eighteen untreated patients with moderate to severe essential hypertension based on the WHO/ISH guidelines participated in this study. Subjects were treated with either an angiotensin-converting enzyme inhibitor alone (group I: 10 patients, 4 men and 6 women, mean age 56 +/- 18 yr) or an angiotensin-converting enzyme inhibitor plus spironolactone (group II: 8 patients, 3 men and 5 women, mean age 59 +/- 14 yr) for 9 mo. Left ventricular mass index, various echocardiographic variables, mean blood pressure, plasma renin activity, and plasma aldosterone concentration before treatment were similar in the two groups. Blood pressure of both groups decreased significantly and similarly after antihypertensive treatment (group I, 136 +/- 9/82 +/- 9 mmHg; group II, 133 +/- 9/85 +/- 10 mmHg), Left ventricular mass index also decreased significantly in both groups (group I, -10.2 +/- 7.1%; group II, -18.1 +/- 6.9%). The extent of reduction was significantly greater in the spironolactone group (group II) (p < 0.05 vs. group I). In group II patients, spironolactone did not cause any side effects during the observation period. We conclude that spironolactone may have beneficial effects on left ventricular hypertrophy in patients with essential hypertension who are receiving an angiotensin-converting enzyme inhibitor.
引用
收藏
页码:17 / 22
页数:6
相关论文
共 37 条
[31]   NONGENOMIC EFFECTS OF ALDOSTERONE ON INTRACELLULAR CA2+ IN VASCULAR SMOOTH-MUSCLE CELLS [J].
WEHLING, M ;
NEYLON, CB ;
FULLERTON, M ;
BOBIK, A ;
FUNDER, JW .
CIRCULATION RESEARCH, 1995, 76 (06) :973-979
[32]   TREATMENT OF HYPERTENSION WITH SPIRONOLACTONE - DOUBLE-BLIND STUDY [J].
WOLF, RL ;
MENDLOWI.M ;
ROBOZ, J ;
STYAN, GPH ;
KORNFELD, P ;
WEIGL, A .
JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1966, 198 (11) :1143-&
[33]   DETERMINANTS OF CARDIAC FIBROSIS IN EXPERIMENTAL HYPERMINERALOCORTICOID STATES [J].
YOUNG, M ;
HEAD, G ;
FUNDER, J .
AMERICAN JOURNAL OF PHYSIOLOGY-ENDOCRINOLOGY AND METABOLISM, 1995, 269 (04) :E657-E662
[34]   MINERALOCORTICOIDS, HYPERTENSION, AND CARDIAC FIBROSIS [J].
YOUNG, M ;
FULLERTON, M ;
DILLEY, R ;
FUNDER, J .
JOURNAL OF CLINICAL INVESTIGATION, 1994, 93 (06) :2578-2583
[35]   The renin-angiotensin-aldosterone system in experimental mineralocorticoid-salt-induced cardiac fibrosis [J].
Young, MJ ;
Funder, JW .
AMERICAN JOURNAL OF PHYSIOLOGY-ENDOCRINOLOGY AND METABOLISM, 1996, 271 (05) :E883-E888
[37]  
ZANCHETTI A, 1993, HYPERTENSION, V22, P392