Nutahara Kikuo, Higashihara Eiji, Horie Shigeo, Kamura Kouichi, Tsuchiya Ken, Mochizuki Toshio, Hosoya Tatsuo, Nakayama Tomohiro, Yamamoto Norio, Higaki Yoshio, Shimizu Toshiko
Department of Urology, Kyorin University School of Medicine, Tokyo, Japan.
Nephron Clin Pract. 2005;99(1):c18-23. doi: 10.1159/000081790.
Although hypertension is commonly found in patients with autosomal dominant polycystic kidney disease (ADPKD), there is no consensus about which antihypertensive agents are most appropriate. The effects of calcium channel blockers (CCB) and angiotensin II receptor blockers (ARB) on blood pressure and renoprotection were compared in hypertensive patients with ADPKD.
We randomly assigned 49 participants to CCB amlodipine-based (2.5-10 mg/day) or ARB candesartan-based (2-8 mg/day) regimens. Twenty-five patients (13 males and 12 females) received amlodipine, and 24 patients (13 males and 11 females) received candesartan. This was followed up for 36 months.
Baseline characteristics were similar, and blood pressure was well controlled in both groups throughout the study period. Six out of 25 (24.0%) amlodipine and 1 out of 24 (4.2%) candesartan patients were terminated from the protocol due to a twofold increase in serum creatinine and/or decrease in creatinine clearance (Ccr) to half of the baseline. The renal event-free survival rate was significant (p < 0.05, Breslow-Gehan-Wilcoxon test). Serum creatinine was higher in the amlodipine group than in the candesartan group at 24 and 36 months (p < 0.05). The decrease in Ccr at 36 months was larger in the amlodipine group than in the candesartan group (DeltaCcr: -20.9 +/- 13.1 vs. -4.8 +/- 13.8 ml/min, p < 0.01). Urinary protein excretion was significantly lower in the candesartan group than in the amlodipine group at 36 months. Urinary albumin excretion was significantly lower in the candesartan group than in the amlodipine group at 12, 24 and 36 months.
The renoprotective effect of candesartan is considered more favorable than amlodipine in the treatment of ADPKD. This is independent of the antihypertensive effect per se.
虽然高血压在常染色体显性遗传性多囊肾病（ADPKD）患者中很常见，但对于哪种抗高血压药物最为合适尚无共识。本研究比较了钙通道阻滞剂（CCB）和血管紧张素II受体阻滞剂（ARB）对ADPKD高血压患者血压及肾脏保护作用的影响。
我们将49名参与者随机分配至以氨氯地平为基础的CCB方案（2.5 - 10毫克/天）或以坎地沙坦为基础的ARB方案（2 - 8毫克/天）。25名患者（13名男性和12名女性）接受氨氯地平治疗，24名患者（13名男性和11名女性）接受坎地沙坦治疗。随访36个月。
两组患者的基线特征相似，在整个研究期间两组血压均得到良好控制。25名接受氨氯地平治疗的患者中有6名（24.0%）、24名接受坎地沙坦治疗的患者中有1名（4.2%）因血清肌酐升高两倍和/或肌酐清除率（Ccr）降至基线的一半而退出研究。肾脏无事件生存率差异有统计学意义（p < 0.05，Breslow - Gehan - Wilcoxon检验）。在24个月和36个月时，氨氯地平组的血清肌酐高于坎地沙坦组（p < 0.05）。在36个月时，氨氯地平组Ccr的下降幅度大于坎地沙坦组（ΔCcr：-20.9 ± 13.1对-4.8 ± 13.8毫升/分钟，p < 0.01）。在36个月时，坎地沙坦组的尿蛋白排泄显著低于氨氯地平组。在12个月、24个月和36个月时，坎地沙坦组的尿白蛋白排泄显著低于氨氯地平组。
在ADPKD的治疗中，坎地沙坦的肾脏保护作用被认为比氨氯地平更有利。这独立于其本身的降压作用。
