Origlnal Articles Korean Circulation J 1998;288:1299-1306 고혈압환자에서 Losartan(Cozaar ) 의임상적효과 김남호 1 정명호 1,3 박우석 1 김성희 1 김준우 1 조장현 1 안영근 1 김남호 2,3 박주형 1 조정관 1,3 박종춘 1,3 강정채 1,3 The Clinical Effects of LosartanCozaar on Hypertensive Patients Nam Ho Kim, MD 1, Myung Ho Jeong, MD 1,3, Woo Suck Park, MD 1, Seong Hee Kim, MD 1, Joon Woo Kim, MD 1, Jang Hyun Cho, MD 1, Young Keun Ahn, MD 1, Nam Ho Kim, MD 2,3, Joo Hyung Park, MD 1, Jeong Gwan Cho, MD 1,3, Jong Chun Park, MD 1,3 and Jung Chaee Kang, MD 1,3 1 Division of Cardiology and 2 Nephrology, Department of Internal Medicine, Chonnam University Hospital, 3 The Research Institute of Medical Sciences, Chonnam National University, Kwangju, Korea ABSTRACT BackgroundLosartan potassium, one of an orally active, selective type 1 angiotensin receptor blocker, has been introduced recently as an antihypertensive agent. MethodLosartan, angiotensin receptor blocker, was administrated as an initial antihypertensive agent over 12 weeks in 30 patients 11 male, 19 female, 60.17.2 years with stage 1 to 3 hypertension in order to observe the clinical effects. Changes in quality of life, side effects, electrocardiogram and left ventricular function were also evaluated before and after losartan therapy. Results1 After 12 weeks treatment with 50 to 100 mg of losartan, blood pressure was lowered markedly in 18 60%, moderately in 9 30% and mildly in 1 3% out of 30 patients studied. The average of blood pressures of the 30 subjects were systolic 159.013.2 mmhg and diastolic 100.79.4 mmhg before treatment, which were lowered to 130.715.6 and 85.99.1 mmhg respectively after 12 weeks p0.005. 2 Heart rates were not changed with losartan. 3 Quality of life including general well-being, physical symptom, sleep and sexual dysfunction improved markedly in 2 7% and slightly in 17 57% out of 30 subjects. 4 Laboratory findings revealed no significant changes. 5 In electrocardiographic and echocardiographic follow-up 1 patient with ST-T abnormality and 2 patients with mild LV systolic dysfunction improved to normal. 6 Undesirable side effects were observed in 2 cases with dizziness, 1 dry cough, 1 skin rash, 1 leg edema and 1 epigastric discomfort, among whom one with dizziness stopped losartan. 7 In the final clinical assessment according to the scores of hypotensive effect, quality of life, LV function and side effect, losartan was very useful in 3 10%, useful in 18 60% and slightly useful in 3 10% out of 30 hypertensive patients. ConclusionLosartan can be used as an effective initial agent for the treatment of hypertension of various severities with the improvement of quality of life and low side effects. Korean Circulation J 1998;288:1299-1306 KEY WORDSHypertension Losartan Angiotensin receptor blocker. 1299
서론 대상환자및방법 결과 임상적양상 Table 1. Classification of hypertension in studied patients Classification Number Mild 140159/9099 mmhg 6 Moderate 160179/100109 mmhg 16 Severe 180/110 mmhg 8 1300 Korean Circulation J 1998;288:1299-1306
Table 2. Age and sex distribution Age Male Female Total 49 2 0 2 5059 3 9 12 6069 3 9 12 70 3 1 4 Total 11 19 30 혈압변화 Table 3. Clinical characteristics and losartan dosage Case No. Age/Sex B.P. Dosage EKG Creatinine LVEF TC/HDL-C 1 60/M 170/100 100 WNL 0.9 44 252/40 2 48/M 170/110 100 LVHST 1.2 72 164/27 3 56/F 160/100 50 LVH 0.8 68 243/58 4 56/F 160/100 WNL 0.8 236/37 5 50/F 160/100 50 ST 0.8 74 252/45 6 61/F 150/100 50 LVHST 0.8 77 232/42 7 53/M 150/100 50 LVHST 1.1 65 268/103 8 68/F 150/90 50 WNL 0.8 81 165/21 9 51/M 160/100 50 ST 1.4 69 256/31 10 63/F 170/100 50 ST 0.9 56 278/62 11 70/M 160/90 50 LVH 1.1 76 12 59/F 170/120 50 WNL 0.7 63 201/70 13 49/M 150/100 50 LVHST 0.8 44 164/43 14 57/F 150/90 50 WNL 0.7 61 113/44 15 74/M 170/100 50 WNL 1.3 80 223/43 16 52/F 180/110 100 LVHST 0.7 76 194/68 17 70/F 140/90 50 LVH 1.2 193/44 18 58/M 160/110 50 ST 1.0 63 190/44 19 61/M 150/90 100 WNL 0.9 179/33 20 72/M 140/90 50 LVH 1.1 61 231/47 21 69/F 140/90 50 ST 0.7 49 213/51 22 55/F 140/100 50 WN L 1.2 200/50 23 57/F 160/110 50 LVH 1.1 89 240/63 24 67/F 170/110 50 WNL 0.8 73 246/45 23 61/F 160/100 50 ST 0.8 76 222/45 26 53/F 150/90 50 LVH 0.9 62 192/38 27 65/F 170/130 100 LVHST 0.7 75 209/42 28 60/F 200/100 100 LVHST 0.8 60 173/44 29 68/F 150/100 50 ST 0.6 66 172/44 30 60/M 160/100 100 WNL 1.1 69 162/49 LVEFleft ventricual ejection fraction, TCtotal cholesterol, HDL-Chigh density lipoprotein-cholesterol, WNLwithin normal limit, LVHleft ventricular hypertrophy, STST-T segment abnormality 1301
심박동수의변화 Table 4. Hypotensive effects on the severity of hypertension Hypertension Mild Moderate Severe Total % Changes Marked fall 2 11 5 18 60 Moderate fall 2 4 3 9 30 Mild fall 1 0 0 1 3 No change 1 1 0 2 7 Total 6 16 8 30 생활의질에관한변화 검사실소견의변화 심전도및좌심실기능의변화 Fig. 1. Changes of systolic and diastolic blood pressure before and after losartan administration *p0.005. 1302 Korean Circulation J 1998;288:1299-1306
Table 5. Blood pressure and heart rate changes before and after losartan administration Case Blood pressure mmhg Heart rate /min No. Before After Before After 1 170/100 140/90 84 60 2 170/110 150/100 72 72 3 160/100 130/90 80 76 4 160/100 stop 92 stop 5 160/100 120/80 74 78 6 150/100 150/90 76 78 7 150/100 140/90 82 72 8 150/90 110/70 67 70 9 160/100 130/80 84 84 10 170/100 110/70 74 72 11 160/90 130/90 80 64 12 170/120 140/90 69 62 13 150/100 100/70 70 70 14 150/90 110/80 76 65 15 170/100 110/80 84 76 16 180/110 120/80 58 61 17 140/90 130/80 65 60 18 160/110 140/100 70 59 19 150/90 120/90 83 80 20 140/90 130/90 90 77 21 140/90 140/90 61 78 22 140/100 130/80 88 80 23 160/110 140/100 72 85 24 170/110 130/80 66 65 25 160/100 110/80 68 72 26 150/90 130/80 60 82 27 170/130 140/90 60 69 28 200/100 170/100 58 57 29 150/100 140/90 64 68 30 160/100 150/100 64 62 Mean159.013.2/ SD 100.79.4 130.715.6/ 85.99.1 73.09.9 70.88.2 Table 6. Changes in quality of life Case No General Physical well-being symptom Sleep and sexual dysfunction Total score 1 2 0 0 3 0 4 0 0 5 0 6 0 7 0 8 9 0 10 0 0 11 0 0 12 13 0 0 14 0 0 15 0 0 16 0 0 17 0 0 18 0 19 0 0 20 0 21 0 0 22 23 0 0 24 0 25 0 26 0 27 0 0 28 0 0 0 0 29 0 0 30 0 0 0 0 improved, 0no change, worsened, 3 markedly improved, 12slightly improved, 0 no change, 13aggravated 부작용 종합적임상유용성판정 고찰 1303
Table 7. Side effects after losartan Side effects Case No. Percentage (%) Persistent cough 1 3 Skin rash 1 3 Dizziness 2 6 Leg edema 1 3 Epigastric discomfort 1 3 Total 6 20 Table 8. Final assessment of losartan effects Case No. Hypotensive effect Quality of life Side effect Improvement of LV function Total score Conclusion 1 4 very useful 2 2 useful 3 0 useless 4 0 2 useless 5 3 useful 6 2 useful 7 2 useful 8 1 slightly useful 9 3 useful 10 0 useless 11 0 useless 12 very useful 13 3 useful 14 0 useless 15 2 useful 16 1 slightly useful 17 2 useful 18 2 useful 19 3 useful 20 2 useful 21 0 2 useful 22 4 very useful 23 2 useful 24 3 useful 25 0 2 useful 26 2 useful 27 0 useless 28 0 2 useful 29 2 useful 30 0 1 slightly useful 45very useful, 23useful, 1slightly useful, 0useless 1304 Korean Circulation J 1998;288:1299-1306
요약 연구배경 : 방법 : 1305
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