洛沙坦及开博通对高血压患者肾功能的影响

Effects of losartan and captopril on renal function in hypertensives

目的:评价开博通及洛沙坦对高血压患者血清肌酐、肌酐清除率、尿蛋白排泌、尿酸的影响.方法:选取56例Ⅰ～Ⅱ级,中-高度危险的高血压痛住院患者,停用抗高血压药物1周后分为两组:(1)开博通组:服开博通12.5mg,3次/日.(2)洛沙坦组:服洛沙坦50～100mg,1次/日.两组于治疗前后测定血压、血清肌酐及肌酐清除率、24小时尿蛋白及尿微量白蛋白、血清尿酸水平并观察药物副作用.结果:共51例完成实验,两组患者治疗前后血压比较均有极显著降低(P《0.01),洛沙坦组血压降低3.33/1.86kPa,开博通组血压平均降低3.38/2.17kPa.两组间降压幅度差异无显著性(P》0.05).开博通组及洛沙坦组治疗前后血清肌酐水平明显下降(P《0.05),但肌酐清除率无显著差异.尿中24小时总蛋白排泌明显减少,开博通组血清尿酸水平治疗前后无明显差异,但洛沙坦组显著降低(P《0.05).结论:开博通及洛沙坦对高血压伴轻、中度肾功能减退患者是有益的,它们均可降低血肌酐及尿蛋白的水平,不影响肌酐清除率,但洛沙坦较开博通更明显降低尿总蛋白的排泌,而且有独特的降尿酸作用,无咳嗽副反应,对高血压患者早期靶器官保护更加有益.

Objective:To evaluate the effects of losartan(Los) and captopril (Cap) on serum creatinine, creatinine clearance, urinary protein excretion and serum uric acid in patients with essential hypertension(EH). Methods:Fifty-six patients with EH of grade I-II, at median to high risk(1999 WHO/ISH Hypertension Guidelines) were enrolled. After 1 week’s washout, the patients were allocated to Los Treatment Group (n=26)(received Los 50-100mg/d for 4 weeks) and Cap Treatment Group (n=30)(received Cap 12.5mg tid for 4 weeks). Before and after treatment, blood pressure(BP), serum creatinine(Cr), creatinine clearance(Ccr), urinary protein excretion(UPE), urinary microalbumin excretion(UAE) and serum uric acid(UA) were determined, symptoms and signs were recorded. Results:The evaluation of Fifty-one patients was completed. At the end of 4 weeks’treatment, BP was significantly decreased(P<0.05), SBP/DBP was 3.33/1.86kPa decreased by Los and 3.38/2.17 kPa by Cap, no statistical significant difference was observed in BP reduction between Los Group and Cap Group(P>0.05). In both groups, Cr was decreased significantly(P<0.05), but Ccr did not change significantly(P>0.05) after treatment. The 24 h UPE and UAE were decreased significantly both in Cap Group and Los Group(P<0.01). Serum UA was decreased significantly in Los Group(P<0.05) but not in Cap Group(P>0.05). Conclusion:The results indicate that both Los and Cap exert hypotensive and renoprotective effects in hypertensives with mild to moderate renal impairment. Los is more efficient in reduction of 24 h UPE and serum UA, and free from the side effect of coughing, it is more profitable and safe.