Hayashi Koichi
Department of Internal Medicine, School of Medicine, Keio University.
Nihon Rinsho. 2004 Jan;62(1):135-41.
Hypertension constitutes a pivotal determinant of the progression of renal disease, which would raise the risk for cardiovascular events. From the standpoint of renal micro-circulation, correction of glomerular hypertension could retard the development of renal injury, which is attainable by the reduction in renal efferent arteriolar resistance as well as systemic blood pressure. Although both ACE inhibitors and angiotensin receptor blockers are established as a tool for improving glomerular hypertension, whether calcium antagonists ameliorate this abnormality remains unclear. However, recent clinical trials including ALLHAT and INSIGHT demonstrate a beneficial action of amlodipine and nifedipine on the development of renal injury. Therefore, calcium antagonists can be used not only as a first line drug, but also as add-on therapy that could potentiate the hypotensive action of underlying medication.
高血压是肾脏疾病进展的关键决定因素，会增加心血管事件的风险。从肾脏微循环的角度来看，纠正肾小球高血压可延缓肾损伤的发展，这可以通过降低肾出球小动脉阻力以及全身血压来实现。虽然血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂都已被确立为改善肾小球高血压的手段，但钙拮抗剂是否能改善这种异常情况仍不清楚。然而，包括抗高血压和降脂治疗预防心脏病发作试验（ALLHAT）和国际硝苯地平控释片治疗高血压干预试验（INSIGHT）在内的近期临床试验表明，氨氯地平和硝苯地平对肾损伤的发展具有有益作用。因此，钙拮抗剂不仅可以用作一线药物，还可以作为增强基础用药降压作用的附加治疗药物。
