从循证医学看长效钙通道阻滞药在透析高血压患者中的应用

Application of long-acting calcium channel blockades from the evidence-based medicine in dialysis patients with hypertension

大多数终末期肾病透析患者合并高血压,这已成为透析患者CVD的首位死因。钙通道阻滞药(CCBs)起效迅速,降压效果显著,且不受钠负荷影响,尤其是近年来大量长效CCBs在心脑血管疾病方面的临床试验证实了其安全性及有效性,使得长效CCBs被广泛应用于临床,亦成为透析高血压患者的一线降压药物。但目前就长效CCBs在肾脏科领域尤其是透析患者这一特殊群体中的讨论远较RAS阻滞药类少,亦缺乏以长效CCBs为主大型临床试验。本文主要结合近年来有限的循证医学证据来探讨长效CCBs在透析高血压患者中应用的有效性、安全性及不确定性。

Hypertension occurs in most patients with end -stage renal disease and likely contributes to the premature cardiovascular disease -the leading cause of death antihypertension of calcium channel blockades（CCBs） is and disability for dialysis patients. The effect of rapid and remarkable, and also can＇t be affected by the sodium load. Further more,as a large number of long -acting CCBs clinical trials in cardiovascular diseases confirm its safety and effectiveness, long -acting CCBs are widely used, and also become the first - line antihypertension agent in dialysic patients with hypertension. But the discussion of CCBs in the field of kidney disease especially in the dialysic patients is more less than RAS inhibition,and it is st a lack of large - scale clinical trials of long - acting CCBs. The aim of this review is to briefly discuss the efficacy,safety and controversy of long - acting CCBs based on recent clinical studies and evidence - based medicine.