Weinbergová Otilie, Metelka Rudolf, Vymetal Jirí, Konecný Karel, Kosatíková Zdena
Faculty of Medicine, Palacky University, Olomouc, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2004 Jul;148(1):69-73.
The primary aim of this study was evaluation of the efficacy of telmisartan (angiotensin II receptor blocker- AT(1) blocker) on blood pressure in 10 patients with renal impairment in moderate or advanced stages of renal insufficiency and not dependent on haemodialysis. Its effect on proteinuria, renal function (represented by serum urea, creatinine, glomerular filtration), evaluation of overall therapy compliance in comparison with a previously prescribed angiotensin converting enzyme inhibitors (ACEI) were secondary aims. Considering the presence of left ventricle hypertrophy in all patients as a marker of hypertensive cardiopathy, the effect of telmisartan therapy on non-invasive cardiovascular parameters (ECG, echocardiography, and assessment of heart rate variability-HRV) was also evaluated. The study group involved 10 hypertensive patients (6 women, 4 men) with diabetic and non-diabetic renal impairment, proteinuria above 1 g/24 hours, hypertensive cardiopathy and intolerance of ACEI (cough). Telmisartan was added to their long-term antihypertensive combination therapy in a dose of 40 mg for the first 14 days, after which the dose increased to the maximal of 80 mg. The average initial daytime systolic blood pressure (SBP) was 149 +/- 19.7 mm Hg, average night-time SBP 145 +/- 23.0 mm Hg, average initial daytime diastolic BP (DBP) 90.6 +/- 2.5 mm Hg, night-time DBP 88.9 +/- 13.5 mm Hg. Average initial serum creatinine was 207.2 +/- 48.5 micromol/l, urea 15.1 +/- 4.4 mmol/l, GF 0.5 +/- 0.1 ml/s. Echocardiography revealed left ventricular (LV) hypertrophy with well preserved systolic and moderately impaired diastolic LV function. Also the HRV assessment revealed impaired neurovegetative (e.g. sympathovagal) balance. After 1 year of combination therapy with telmisartan, there was a clearly significant reduction in both SBP and DBP in both day and night-time (SBP daytime 149.6 vs.116.6 mm Hg, night-time 145.8 vs. 129.5 mm Hg; DBP daytime 90.6 vs. 83.5 mm Hg, night-time 88.9 vs. 79.3 mm Hg) and proteinuria (2.37 vs. 1.27 g/24 hour, p < 0.05). There were no significant changes in serum creatinine, urea values, and LV functions. On the other hand, further progression of the sympathovagal balance impairment was noted (continuing reduction of HRV in 9 from 10 patients), which can be described as the priority finding. The total compliance of telmisartan therapy was very good and without adverse clinical side effects. In conclusion - telmisartan reduces blood pressure and proteinuria safely and effectively in patients with various types of nephropathy in moderate or advanced stages of renal insufficiency.
本研究的主要目的是评估替米沙坦（血管紧张素II受体阻滞剂 - AT(1) 阻滞剂）对10例处于肾功能不全中晚期且不依赖血液透析的肾功能损害患者血压的疗效。其对蛋白尿、肾功能（以血清尿素、肌酐、肾小球滤过率表示）的影响，以及与先前开具的血管紧张素转换酶抑制剂（ACEI）相比总体治疗依从性的评估为次要目的。鉴于所有患者均存在左心室肥厚作为高血压性心脏病的标志物，还评估了替米沙坦治疗对无创心血管参数（心电图、超声心动图以及心率变异性 - HRV评估）的影响。研究组包括10例高血压患者（6名女性，4名男性），患有糖尿病和非糖尿病性肾功能损害，蛋白尿超过1 g/24小时，患有高血压性心脏病且对ACEI不耐受（咳嗽）。在其长期降压联合治疗中添加替米沙坦，前14天剂量为40 mg，之后剂量增至最大80 mg。平均初始日间收缩压（SBP）为149±19.7 mmHg，平均夜间SBP为145±23.0 mmHg，平均初始日间舒张压（DBP）为90.6±2.5 mmHg，夜间DBP为88.9±13.5 mmHg。平均初始血清肌酐为207.2±48.5 μmol/l，尿素为15.1±4.4 mmol/l，肾小球滤过率（GF）为0.5±0.1 ml/s。超声心动图显示左心室（LV）肥厚，收缩功能良好，舒张功能中度受损。HRV评估也显示神经植物性（如交感 - 迷走神经）平衡受损。在与替米沙坦联合治疗1年后，日间和夜间的SBP和DBP均有明显显著降低（日间SBP 149.6 vs. 116.6 mmHg，夜间145.8 vs. 129.5 mmHg；日间DBP 90.6 vs. 83.5 mmHg，夜间88.9 vs. 79.3 mmHg）以及蛋白尿（2.37 vs. 1.27 g/24小时，p < 0.05）。血清肌酐、尿素值和左心室功能无显著变化。另一方面，注意到交感 - 迷走神经平衡损害进一步进展（10例患者中有9例HRV持续降低），这可被描述为首要发现。替米沙坦治疗的总体依从性非常好且无不良临床副作用。总之，替米沙坦可安全有效地降低肾功能不全中晚期各种类型肾病患者的血压和蛋白尿。
