Hipertansif bireylerde beta-bloker ve spironolaktonun serum homosistem düzeylerine etkileri

The effects of beta-blockers and spironolactone in hypertensive patients on serum homocystein levels

İlyas ATAR,Şenol DEMİRCAN,Mehmet Emin KORKMAZ,İnci Aslı SONAT,Serpil TAYMAZ,AYLİN YILDIRIR,Bülent ÖZİN,Münire TURAN,Haldun MÜDERRİSOĞLU

Özet

AMAÇ: Hipertansif bireylerde homosistein seviyesinin normalden yüksek olduğu gösterilmiştir ve yapılan iki çalışmada tesadüfi olarak beta-bloker (BB) kullananlarda homosistein düzeyi düşük saptanmıştır. Biz hipertansif bireylerde BB'lerin ve anti-aldesteron etkisi de olan bir diüretik olan spironolaktonun plazma homosistein düzeyi üzerine olan etkilerini inceledik. GEREÇ VE YÖNTEM: Yeni hipertansiyon tanısı alan ve ilaç kullanmayan 65 hasta 50 mg/gün spironolakton veya 100 mg/gün metoprolol gruplarına randomize edildi. Kan basınçları normale gelmeyen ( 0.05) ve bu değer minimal artmakla beraber 5. ayda da sebat etmiştir (13.2±5.0 µmol/L, p>0.05). SONUÇ: B-blokerler hipertansif bireylerde homosistein düzeyini düşürmekte ve spironolakton ise homosistein düzeyini değiştirmemektedir. Bu bulguların desteklenmesi için daha geniş çalışmalara ihtiyaç vardır.

Abstract

AIM: It has been shown that serum levels of homocysteine are elevated in hypertensive patients. In two studies it has been also shown that among hypertensives who use beta-blockers (BB) homocysteine levels are lower than normals. We investigated the effects of BB and spironolactone on homocysteine levels. MATERIAL AND METHODS: To investigate this hypothesis we enrolled newly diagnosed 65 hypertensive patients who had not used any medication. Patients were randomized to either spironolactone 50 mg/day or metoprolol 100 mg/day. If their blood pressures were not normalized doses of both drugs were doubled. Homocystein levels were investigated at baseline, 1st and 5th months after the commencement of therapy. RESULTS: In patients receiving metoprolol, serum homocysteine levels decreased in the 1st month and this was more pronounced in the 5th month (from 13.5 ± 4.4 to 12.4 ± 4.0 to 11.9 ± 2.5 µmol/L, p = 0.011). In spironolactone group there was no significant change from the baseline both on the 1st and 5th months (from 13.6 ± 8.3 to 13.1 ± 5.4 to 13.2 ± 5.0 µmol/L, p> 0.05). CONCLUSIONS: The data suggest that the selective BB; metoprolol decreases plasma homocysteine levels in hypertensive patients, whereas spironolactone does not have this effect.

Anahtar kelimeler: Kan basıncı,Homosistein,Hipertansiyon,Metoprolol,Spironolakton