关键词: 高血压, 螺内酯, 特拉唑嗪, 比索洛尔, 肾功能, 治疗结果, 安全性

Abstract: Objective　We aimed to explore a better regimen for refractory hypertension patients by comparing the effectiveness and safety of spironolactone versus terazosin and bisoprolol.Methods　Totals of 120 patients with refractory hypertension were enrolled from January 1，2015 to June 30，2017.They were equally divided into groups 1，2，and 3 in a randomized order，receiving 12 consecutive weeks of once daily treatment with bisoprolol（5 mg），terazosin hydrochloride tablets（2 mg），spironolactone（20 mg），respectively，in addition to their baseline antihypertensive drugs.During this period，no drugs were changed.Blood pressure control status，glycosylated hemoglobin（HbA1c），low-density lipoprotein，serum potassium，estimated glomerular filtration rate（eGFR），urinary albumin to creatinine ratio （UACR） and so on were measured before and at the end of the intervention.Adverse events occurred during the intervention period were recorded.Results　The overall response rate differed significantly among the three groups（χ2=8.81，P<0.05）．Moreover，pairwise comparisons indicated that spironolactone group showed a significantly different overall response rate when compared with each of other two groups（P<0.017），but terazosin group demonstrated a overall response rate similar to bisoprolol group（P>0.017）．The overall antihypertensive effectiveness varied significantly among the three groups（P<0.05）．Moreover，pairwise comparisons found that the blood pressure was lowered more obviously in spironolactone group compared with each of other two groups（P<0.05），while similar reductions in blood pressure were found in both terazosin group and bisoprolol group（P>0.05）．Compared with baseline，at the end of intervention，UACR improved significantly in spironolactone group （P<0.05），but not in other two groups（P>0.05）．Conclusion　For refractory hypertension，spironolactone is superior to terazosin and bisoprolol in terms of antihypertensive effectiveness and renal function protection，which can be used as an optimal fourth-line drug for refractory hypertension and is worthy of clinical promotion.

Key words: Hypertension, Spironolactone, Terazosin, Bisoprolol, Renal function, Treatment outcome, Safety