氨氯地平和培哚普利联合治疗对高血压病患者肾功能的影响

Effect of combined treatment by amlodipine and perindopril on renal function in patients with essential hypertension

目的探讨氨氯地平、培哚普利单独治疗和联合治疗对高血压病患者肾功能的影响。方法６６例高血压病患者随机分为三组：氨氯地平组（５ｍｇ，ｑｄ，２２例）；培哚普利组（４ｍｇ，ｑｄ，２２例）；氨氯地平和培哚普利联合治疗组（氨氯地平５ｍｇ，ｑｄ；培哚普利４ｍｇ，ｑｄ，２２例）。疗程２４周，治疗前后观察肾功能指标变化。结果（１）氨氯地平、培哚普利及联合治疗组高血压病患者治疗后均能显著降低血压（Ｐ＜０．０１）及尿蛋白的排泄量［２４小时尿白蛋白（ｍｇ／２４ｈ）：１０２．８±３６．４，１０４．７±４２．７和１０１．４±３６．７分别降至６８．７±２９．１，６６．４±２６．３和４４．４±１６．８，Ｐ均＜０．０１；２４小时尿蛋白（ｇ／Ｌ）：０．２４±０．０６５，０．２４±０．０６２及０．２３±０．０６６分别降至０．１７±０．０３１，０．１７±０．０４４和０．１１±０．０４１，Ｐ均＜０．０１］。但联合治疗组降低尿蛋白排泄的幅度比氨氯地平组、培哚普利组明显高［２４小时尿白蛋白（ｍｇ／２４ｈ）：５７．３±１９．６比３５．２±１４．５，３７．４±１９．３，Ｐ均＜０．０５；２４小时尿蛋白（ｇ／Ｌ）：０．１１±０．０４３比０．０６９±０．０３６，?

Objective To examine the effect of amlodipine and perindopril used individually or in combination on renal function in patients with essential hypertension (EH). Methods Sixty six cases with EH were divided randomly into three groups: amlodipine (5 mg qd, n=22), perindopril (4mg qd, n=22) and combined treatment (amlodipine 5 mg qd+perindopril 4mg qd, n=22). Treatment lasted for 24 weeks. Parameters of renal function were measured before and after treatment. Results (1) After treatment, urinary albumin excretions were significantly less than those before treatment in all the three groups [urinary albumin excretion mg/24h: 68.7±29.1, 66.4±26.3 and 44.4±16.8 vs 102.8± 36.4, 104.7±42.7 and 101.4±36.7 respectively, all P <0.01; 24h urine protein g/L: 0.17±0.031, 0.17±0.044 and 0.11±0.041 vs 0.24±0.065, 0.24±0.062 and 0.23±0.066 respectively, all P <0.01]. Magnitude of decrease of urinary albumin excretion in the combined treatment group was higher than those in the amlodipine and perindopril groups [urinary albumin excretion mg/24h: 57.3± 19.6 vs 35.2±14.5 and 37.4±19.3, all P <0.05; 24h urine protein g/L: 0.11±0.043 vs 0.069 ± 0.036 and 0.068±0.038, all P <0.01]. No significant difference was found between amlodipine and perindopril groups ( P >0.05). After treatment GFR was increased in the combined treatment and perindopril groups, no significant change was observed in the amlodipine group (123.8±17.6, 124.8±15.4, 120.9±17.4 vs 110.8±15.2, 111.9±13.1, 112.3±15.5 ml/min, P <0.05, <0.05, and >0.05, respectively). (2) No significant correlation between the magnitude of decrease of urinary albumin excreation and that of SBP or DBP was found among all the three groups (P >0.05). Conclusion The data suggest that amlodipine combined with perindopril treatment has additive effect on the decrease of urinary albumin excretion and protection of renal function.