缬沙坦联合氨氯地平对高血压患者肾功能保护作用的研究

Protective effect of valsartan combined with amlodipine on renal function in primary hypertensive

目的评价缬沙坦与氨氯地平联合应用对高血压合并尿微量白蛋白患者肾功能的保护作用。方法回顾性分析高血压合并尿微量白蛋白的患者439例,分为氨氯地平组(A组)79例,缬沙坦组(B组)167例,缬沙坦和氨氯地平联合组(C组)193例。比较3组患者治疗1年后的血压、联合降压药物的数量、尿α1-微球蛋白、尿微量白蛋白、血清肌酐水平和肾小球滤过率等指标变化。结果与治疗前比较,A、B、C组患者治疗后收缩压和舒张压明显下降(P<0.05),B组和C组尿α1-微球蛋白和尿微量白蛋白明显下降(P<0.05)。B组联合用药最多。A组尿微量白蛋白变化差异无统计学意义(P>0.05)。C组血肌酐较A、B组患者明显下降,肾小球滤过率明显升高(P<0.05)。结论对于中老年高血压合并尿微量白蛋白患者,缬沙坦加氨氯地平联合治疗,可以达到强效降压和减轻蛋白尿双重目的 ,有利于延缓肾功能损害。

Objective To evaluate the renal protective effect of valsartan combined with amlodipine in hypertensive with microalbuminuria. Methods 439 patients aged over 50 suffering from hypertension and microalbuminuria were enrolled in the study. These patients were divided into 3 groups：amlodipine（A group）,valsartan（B group） and combination（C group）,all received strictly antihypertensive therapy for 12 months. Amolodipine 2.5--10 mg per day was given in amolodipine group and valsartan 80--60 mg per day was given in valsartan group. Valsartan 80--60 mg and amolodipine 2.5--10 mg per day were given to combination group. Other types of antihypertensive medication were not restricted to use in every group. Blood pressure, numbers of antihyperten sive agents, urinary alfa 1-microglobulin （ al-MG）, urine microalbumin （ m-Alb）, blood creatinine and estimated glomerular filtration rate（eGFR） were compared after treatment for 1 year in 3 groups. Results Average systolic and diastolic blood pressure in 3 groups was decreased markedly as compared with baseline levels（P〈0.05）. There are more antihypertensive drugs in valsartan group than other 2 groups. Urinary α1-MG and m-Alb were markedly reduced in valsartan group and combination group（P〈0.05）. The serum creatinine decreased and eGFR improved in combination group. Conclusion For elderly patients with hypertension and microalburuinuria,the treatment involved with valsartan and amlodipine can help to control blood pressure, reduce proteinuria and delay renal function impairment.