血管紧张素转换酶抑制剂对常染色体显性遗传性多囊肾病高血压患者左心室肥厚的逆转作用

Reversal of left ventricular hypertrophy with angiotensin converting enzyme inhibition in hypertensive patients with autosomal dominant polycystic kidney disease.

作者信息

Ecder T, Edelstein C L, Chapman A B, Johnson A M, Tison L, Gill E A, Brosnahan G M, Schrier R W

机构信息

Department of Medicine, University of Colorado School of Medicine, Denver, USA.

出版信息

Nephrol Dial Transplant. 1999 May;14(5):1113-6. doi: 10.1093/ndt/14.5.1113.

DOI:10.1093/ndt/14.5.1113

PMID:10344347

Abstract

BACKGROUND

Hypertension occurs commonly and early in the natural history of autosomal dominant polycystic kidney disease (ADPKD), affecting both renal and patient outcome. Activation of the renin angiotensin aldosterone system due to cyst expansion and local renal ischaemia plays an important role in the development of ADPKD related hypertension and left ventricular hypertrophy (LVH), a known important risk factor for cardiovascular morbidity and mortality. The aim of this study was to investigate the effects of an angiotensin converting enzyme (ACE) inhibitor, enalapril, on renal function, blood pressure and LVH in hypertensive ADPKD patients.

METHODS

Fourteen hypertensive ADPKD patients (11 men, 3 women; mean age: 40 years) were included in the study. All patients had LVH and creatinine clearance (Cer) greater than 50 ml/min/1.73 m2. The patients were followed for 7 years on enalapril therapy. The effects of enalapril on renal function, blood pressure and LVH were investigated.

RESULTS

Baseline measurements of mean arterial pressure (MAP), Ccr and left ventricular mass index (LVMI) were 110 +/- 2 mmHg, 84 +/- 6 ml/min/1.73 m2 and 146 +/- 4 g/m2, respectively. After one year of enalapril therapy there was a significant decrease in MAP (94 +/- 3 mmHg, P < 0.005) which remained stable until the end of the study at 7 years (94 +/- 1 mmHg, P < 0.005 vs baseline). There was also a significant decrease in LVMI (131 +/- 6 g/m2, P < 0.05) after year 1 which continued to decrease until the end of the study reaching 98 +/- 6 g/m2 (P < 0.01 vs year 1 and baseline). Although Ccr remained stable after year 1, a significant decrease was observed after 7 years of follow-up (59 +/- 6 ml/min, P < 0.001 vs year 1 and baseline).

CONCLUSIONS

ACE inhibition in hypertensive ADPKD patients provided long-term reversal of LVH in association with a mean 3.6 ml/min/year decline of Ccr. These preliminary results have potential important implications for cardiovascular and renal protection in ADPKD.

摘要

背景

高血压在常染色体显性遗传性多囊肾病（ADPKD）的自然病程中常见且出现较早，会影响肾脏及患者预后。囊肿扩张和局部肾脏缺血导致的肾素 - 血管紧张素 - 醛固酮系统激活在ADPKD相关高血压及左心室肥厚（LVH）的发展中起重要作用，左心室肥厚是心血管发病和死亡的一个已知重要危险因素。本研究的目的是调查血管紧张素转换酶（ACE）抑制剂依那普利对高血压ADPKD患者肾功能、血压和左心室肥厚的影响。

方法

14例高血压ADPKD患者（11例男性，3例女性；平均年龄：40岁）纳入本研究。所有患者均有左心室肥厚且肌酐清除率（Cer）大于50 ml/min/1.73 m²。患者接受依那普利治疗7年。研究依那普利对肾功能、血压和左心室肥厚的影响。

结果

平均动脉压（MAP）、Ccr和左心室质量指数（LVMI）的基线测量值分别为110±2 mmHg、84±6 ml/min/1.73 m²和146±4 g/m²。依那普利治疗1年后，MAP显著下降（94±３mmHg，P<0.005），直至7年研究结束时保持稳定（94±1 mmHg，与基线相比P<0.005）。1年后LVMI也显著下降（131±6 g/m²，P<0.05），并持续下降直至研究结束，降至98±6 g/m²（与第1年和基线相比P<0.01）。虽然1年后Ccr保持稳定，但随访7年后观察到显著下降（59±6 ml/min，与第1年和基线相比P<0.001）。