| Objective: Both the arterial stiflhess and myocardial fibrosis are important independent risk factors of the development in cardiovascular diseases. Aldosterone may be the key link of the developed stiffness and one of the promoting factors of the collagen proliferation in cardiovascular system. The purpose of this study is to observe the effects on tissue remodeling, collagen turnover and vessel resistance and the relationship between them by controlling the angiotensin n and aldosteron of RAAS under the premise of controlling blood pressure stably and efficiently. At the same time, an animal experiment was made to confirm the important role of the remedy with spironolactone in the decreasing myocardial fibrosis and the protecting myocardial function.Methord: The animal experiment and the clinical study were made to confirm the role and the necessity of anti-aldosterone remedy on hypertension. The clinical study: 135 patients with hypertension and less than 80 years old were selected and observed for one year. All of them were divided into three groups randomly, including A group: ACEI + little dosage spironolactone, B group: ACEI and C group: intervention with routine therapeutics excluding the drugs effecting on RAAS. The changes of parameters about neuroendocrine (such as rennin, angiotensin n, aldosterone, the rate of aldosterone and rennin, endothelin, etc), collagen turnover (PIIINP), diastolic function (E/A, Ea/Aa, EOT, IVRT) and vessel resistance (SVR) were observed after controlling blood pressure stably and efficiently. The animal experiment: 48 SD rat (150-200g) were divided into 4 groups, including pseudo-operation group, controlling group, ACEI group and ACEI + spironolactone group, after partial abdominal artery ligation in superior ofrenal arteries. The parameters of hemodynamics, hypertrophy and myocardial interstitial collagen deposition were observed in order to verify the effect of anti-aldosterone.Results:The clinical study: Under the same blood pressure controlling precondition, the remedy of anti-aldosterone can decrease serum PfflNP, the rate aldosterone and rennin, the activity of serum endothelin, vessel resistance and left ventricular weight index (LVWI) much more. The reversion of LVWI is related to the remedy of spironolactone and the level of serum PIIINP.The animal experiment: Under the same precondition of the blood pressure controlling and the decreasing of left ventricular thickness, the remedy of anti-aldosterone can protect heart function even better and decrease myocardial interstitial collagen deposition more markedly. That is to say, the protective effect on heart is not dependent on the blood pressure control and regression of left ventricular hypertrophy. The reversion of left ventricular function is related to the remedy of spironolactone and the depression of myocardial interstitial collagen deposition.Conclusion:The patients with essential hypertension will benefit from the remedy of anti-aldosterone no matter what levels of initial plasma aldosterone under the precondition of blood pressure control efficiently.The project of suitable ACEI+ little dosage spironolactone, which aim at depressing RAAS completely, can improve heart function much more and this effect is independent on the blood pressure descending and the regression of hypertrophy according to the results of the animal experimentand the clinical study. The use of spironolactone and the amelioration of myocardial interstitial collagen deposition are two significant causes of improving heart function and reversion of LVWI.It promotes that the remedy of all round controlling RAAS, including angiotensin II and aldosterone control, is better than that of regulating blood pressure with traditional method excluding intervention of RAAS in decreasing the enlargement of LVWI and the aggravation of left ventricular hypertrophy. Therefore, it may be a very significant and necessary fact in improving long term prognosis of hypertension to controlling RAAS all roundly.
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