左旋氨氯地平对血压控制不良患者微量白蛋白尿逆转作用的研究

Reverse effect of L-amlodipine on microalbuminuria in patients with poorly-controlled blood pressure

目的观察不同联合治疗方案对高血压伴微量白蛋白尿(MAU)患者血压控制及白蛋白尿的逆转作用。方法选择使用血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂后,血压仍>140/90 mm Hg(1 mm Hg=0.133 kPa)且MAU阳性的高血压患者94例,随机分为左旋氨氯地平组52例(2.5～5 mg/d)、氢氯噻嗪组42例(1 2.5～25 mg/d),干预12周。观察不同治疗方案对血压控制以及MAU的逆转作用。结果左旋氨氯地平组和氢氯噻嗪组干预1 2周后,血压达标分别为35例和27例(67.3%vs 64.3%,P>0.05)。MAU转阴率分别为53.8%和1 9.0%(P<0.01);血压<140/90 mm Hg同时MAU下降≥30%的比例分别为80.8%和64.3%(P<0.05)。结论肾素-血管紧张素阻滞剂联合钙拮抗剂或利尿剂(氢氯噻嗪)的治疗方案在血压降低以及达标率方面无显著差异。联合钙拮抗剂在降低MAU方面明显优于联合利尿剂方案。

Objective To observe the reverse effect of different combined regimens on blood pres- sure and microalbuminuria（MAU）in hypertensive patients. Methods Ninety-four hypertensive patients with blood pressure〈140/90 mm Hg（1 mm Hg=0. 133 kPa）and positive MAU after treatment with inhibitors of angiotensin invertase and antagonists of angiotensin lI receptor were included in this study. The patients were randomly divided into L-amlodipine group（n= 52） and diuretics（HCTZ） group（n= 42）. After the patients were treated with L-amlodipine（2.5--5 rag/ d） and HCTZ（12.5--25 mg/d）respectively for 12 weeks,the reverse effect of different regimens on blood pressure and MAU was observed. Results The normal blood pressure was achieved in 35（67.3%） and 27 patients（64.3%）respectively（P〉0.05）,the negative MAU rate was 53.8% and 19.0% respectively（P〈0.01） ,the blood pressure was〈140/90 mm Hg and the MAU was 30% in 80.8% and 64.3% of the patients in the two groups 12 weeks after treatment（P〈0.05）. Conclusion The effect of renin and angiotensin blocking agents in combination with calcium antagonists or HCTZ is similar to that of other regimens on blood pressure and other parameters, and is better than that of renin and angiotensin blocking agents in combination with HCTZ.