摘要
目的 探讨血管紧张素Ⅱ受体拮抗剂 (AIRA)和血管紧张素转换酶抑制剂 (ACEI)对原发性高血压 (EH)患者肾功能的影响。方法 采用随机、单盲和平行对照方法 ,经 1周药物冲洗期及 2周安慰剂导入期后 ,6 0例EH患者 (EH组 )进行 16周治疗期 ,每日 1次口服氯沙坦 5 0mg(n =30 )或依那普利 5mg(n =30 ) ,4周后如舒张压 (DBP)≥ 90mmHg(1mmHg =0 133kPa)则剂量加倍。治疗后测量血压、心率 (HR)并记录症状、体征 ;并行 2 4h动态血压监测(ABPM) 1次。治疗前后分别测定血清肌酐 (Cr)、尿素氮 (BUN)、内生肌酐清除率 (Ccr)和 2 4h尿蛋白 (UTP)、白蛋白(Alb) ,尿α1及 β2 微球蛋白 (α1 MG和β2 MG)的排泄率。 2 0例健康体检者作为对照组。结果 ⑴两组药物均能明显降低血压 (P <0 0 0 1)。⑵治疗前EH组患者Ccr显著低于对照组 ,尿α1 MG和 β2 MG及UTP、Alb显著高于对照组 ,且上述指标改变程度与EH的病程相关。⑶治疗 16周后 ,氯沙坦和依那普利均能显著降低尿UTP、Alb ,尿α1 MG和β2 MG ,其中病程较长者 ,下降幅度较大。⑷咳嗽发生率氯沙坦组 (6 7% )明显低于依那普利组 (2 6 7% ) (P <0 0 1)。结论 ⑴EH患者早期即有肾功能损害 ,且随病程延长损害加重。⑵氯沙坦可减轻和延缓高血压引起的肾功能损害 。
Objective To evaluate the effects of angiotensin Ⅱ receptor antagonist and angiotensin converting enzyme inhibitor on the renal function in patients of essential hypertension. Method A randomized, single-blind and parallel study was performed. After 1 week washout and 2 weeks placebo run-in period, 60 patients were randomly assigned to receive either 50 mg losartan ( n =30 ) or 5 mg enalapril ( n =30) once daily for 16 wks. If DBP ≥90 mmHg sustained after 4 wks treatment, the doses of both medications were doubled. At the end of run in period and 16 weeks after treatment, BP, HR, symptoms and signs were estimated; BP was measured by 24 h ambulatory blood pressure monitoring (ABPM). Before and after the treatment, the serum creatinine(Cr), blood urea nitrogen(BUN), endogenous creatinine clearance rate(Ccr), 24 h urine protein excretion [total urine protein(UTP), albumin(Alb)], urine α 1-microglobulin and β 2-microglobulin(α 1-MG and β 2-MG )excretion, urine sodium and potassium were measured. 20 healthy subjects were served as normal control group. Result ⑴ Losartan and enalapril significantly reduced the blood pressure of hypertensive patients after 16 weeks treatment. Blood pressure control in losartan group was similar to that in enalapril group. ⑵ Before treatment, Ccr was significantly lower in EH group than that in control group, UTP, Alb, urine α 1-MG and β 2-MG were significantly higher. ⑶ Both losartan and enalapril treatments decreased UTP and Alb, urine α 1-MG and β 2-MG after 16 weeks treatment. The changes were more significant in patients with disease duration>10 years. ⑷ The prevalence of cough side effect in losartan group was significantly lower than that in enalapril group (6.7% vs 26.7%, P <0.01). Conclusion Losartan improve renal function effectively in patients with hypertension. The protective effects of losartan appears to be comparable to those of enalapril.
出处
《高血压杂志》
CSCD
2003年第3期241-244,共4页
Chinese Journal of Hypertension
