贝尼地平和缬沙坦对原发性高血压伴蛋白尿患者肾脏保护作用的对比

Renal protective effects of benidipine and valsartan in primary hypertension patients with proteinuria

目的比较钙通道阻滞剂贝尼地平与血管紧张素Ⅱ受体拮抗剂缬沙坦对原发性高血压伴蛋白尿患者肾脏保护作用的差别。方法根据24h尿蛋白总量（简称为Pro）和使用药物的不同，将236例原发性高血压伴蛋白尿患者分为4组：A1组（1g／24h≤Pro〈3g／24h，服用贝尼地平8mg／d）、A2组（1g／24h≤Pro〈3∥24h，服用缬沙坦80mgCd）、B1组（Pro〈1g／24h，服用贝尼地平8mg／d）、B2组（Pro〈1g/24h，服用缬沙坦80mg／d）。各组均观察48周，比较应用药物后肾小球滤过率（GFR）、尿蛋白及血压的差别。结果与治疗前比较，治疗24、48周后各组GFR均明显升高（均P〈0．01），但是各组之间GFR差异无统计学意义。与B1组比较，B2组治疗24、48周后Pro明显减少[24周：（0．39±0．06）g/24h比（0．27±0．07）g／24h，P〈0．01；48周：（0．30±0．05）g/24h比（0．18±0．01）g／24h，P〈0．01]。A1组与A2组比较，治疗12、24和48周后Pro差异均无统计学意义。治疗12、24和48周后，A1组与A2组、B1组与B2组间血压差异均无统计学意义。结论贝尼地平和缬沙坦在保护原发性高血压伴蛋白尿患者肾脏功能方面作用相似。

Objective To compare the renal protective effects between calcium channel blocker benidipine and angiotensin Ⅱ receptor blocker valsartan in primary hypertension patients with proteinuria. Methods A total of 236 patients were divided to low （ 〈 1 g/24 h） and high （ 1-3 g/24 h） proteinuria groups and treated with benidipine （8 mg/d） or valsartan （80 mg/d） for 48 weeks. Blood pressure, glomerular filtration rate（GFR） and 24 h protein were measured at baseline, 12, 24 and 48 weeks. Results Blood pressure was significantly and equally reduced in all treated groups （ all P 〈 0.05 vs. baseline）. GFR was also significantly and equally improved in all treated groups after 24 weeks treatments （ all P 〈 0. 05 at 24 weeks and 48 weeks）. Proteinuria reduction at 24 and 48 weeks was more significant in patients treated with valsartan compared to patients treated with benidipine in low proteinuria group [ 24 weeks： （0.27 ± 0.07）g/24hvs. （0.39±0.06）g/24h, P〈0.01;48weeks： （0.18±0.01）g/24hvs. （0.30 ±0.05） g/24 h, P 〈 0.01 ]. Conclusion The renal protection efficacy of vlsartan and benidipine was similar in primary hypertensive patients with proteinuria.