Derwa A, Peeters P, Vanholder R
Nephrology Section, Department of Internal Medicine, University Hospital, De Pintelaan 185 9000 Gent, Belgium.
Acta Clin Belg. 2004 Jan-Feb;59(1):44-56. doi: 10.1179/acb.2004.007.
Hypertension and high levels of proteinuria are independent risk factors for accelerated progression of renal failure. There is increasing evidence that strict control of both blood pressure (BP) and proteinuria are beneficial in slowing the rate of progression of chronic renal disease in diabetic as well as non-diabetic nephropathy. The angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin 2 receptor blockers (ARB) have clearly demonstrated their beneficial effect on both reduction of BP and proteinuria. The calcium channel blockers (CCB) have individual pharmacological and therapeutic properties that may vary, but as a group they are effective antihypertensive agents in patients with renal disease. Their effects on the kidney may extend beyond BP reduction alone. Current studies suggest that CCB do not worsen the progression of renal disease but may rather provide benefit when systemic BP has been tightly normalised. The non-dihydropyridine calcium channel blockers (NDHP), diltiazem and verapamil, slow the progression of type 2 diabetic nephropathy with overt proteinuria almost to a similar extent as observed with ACE-I. The dihydropyridine calcium channel blockers (DHP) have a variable effect on proteinuria. Pharmaceutical compounds, which inhibit the renin-angiotensin system (RAAS), remain the drugs of first choice in the treatment of hypertension and/or proteinuria in chronic nephropathy. However, a combination of two or more drugs is almost always required to attain sufficient BP reduction. CCB may have an advantage in combination with ACE-I and/or ARB.
高血压和高水平蛋白尿是肾衰竭加速进展的独立危险因素。越来越多的证据表明，严格控制血压（BP）和蛋白尿有利于减缓糖尿病肾病和非糖尿病肾病患者慢性肾病的进展速度。血管紧张素转换酶抑制剂（ACE-I）和血管紧张素2受体阻滞剂（ARB）已明确显示出它们在降低血压和蛋白尿方面的有益作用。钙通道阻滞剂（CCB）具有各自不同的药理和治疗特性，可能存在差异，但作为一个类别，它们在肾病患者中是有效的抗高血压药物。它们对肾脏的作用可能不仅限于单纯降低血压。目前的研究表明，CCB不会使肾病进展恶化，反而在全身血压已严格恢复正常时可能带来益处。非二氢吡啶类钙通道阻滞剂（NDHP）、地尔硫䓬和维拉帕米减缓2型糖尿病肾病伴显性蛋白尿进展的程度几乎与ACE-I观察到的相似。二氢吡啶类钙通道阻滞剂（DHP）对蛋白尿的影响不一。抑制肾素-血管紧张素系统（RAAS）的药物仍然是治疗慢性肾病高血压和/或蛋白尿的首选药物。然而，几乎总是需要联合使用两种或更多药物才能充分降低血压。CCB与ACE-I和/或ARB联合使用可能具有优势。
