Tsuchihashi Takuya, Ueno Michio, Tominaga Mitsuhiro, Kajioka Tomoko, Onaka Uran, Eto Kimika, Goto Kenichi
Division of Hypertension, Clinical Research Center, National Kyushu Medical Center, Fukuoka City, Japan.
Clin Exp Hypertens. 2005 Nov;27(8):583-91. doi: 10.1080/10641960500298558.
The objective of the present study was to determine anti-proteinuric effect of an N-type calcium channel blocker-cilnidipine. Subjects were 43 essential or renal hypertensive subjects who had been taking calcium channel blockers other than cilnidipine for at least 6 months. All patients had proteinuria greater than 0.2 g/day in spite of fair blood pressure control (<150/90 mmHg). Calcium channel blockers in 25 patients (62+/-3 years) were switched to cilnidipine (cilnidipine group), whereas other 18 patients (58+/-3 years) continued to take originally prescribed calcium channel blockers (control group). The 24-hr urine collections were done at baseline and after 6 months of the follow-up period. Baseline characteristics including age, blood pressure levels, body mass index and creatinine clearance were similar between cilnidipine and control groups. Urinary protein excretion also was comparable between cilnidipine (0.61+/-0.10 g/day) and control (0.86+/-0.17 g/day) groups. Urinary protein significantly decreased after 6 months in cilnidipine group (- 0.21+/- 0.11 g/day, - 36%, p< 0.01), whereas it did not change in control group (+ 0.01+/- 0.15 g/day, 0.4%, ns). There were no significant changes in blood pressure, serum creatinine, creatinine clearance, estimated protein intake, and urinary salt excretion during the follow-up period in either group. The reduction of urinary protein by cilnidipine was evident in essential hypertensives (- 54+/-9%, n=18, p<0.01) but not in renal hypertensives (+10+/-35%, n=7, ns). Results suggest that cilnidipine has an anti-proteinuric effect especially in patients with essential hypertension.
本研究的目的是确定N型钙通道阻滞剂西尼地平的抗蛋白尿作用。研究对象为43例原发性或肾性高血压患者，他们服用除西尼地平以外的钙通道阻滞剂至少6个月。尽管血压控制良好（<150/90 mmHg），但所有患者的蛋白尿均大于0.2 g/天。25例患者（62±3岁）的钙通道阻滞剂换用西尼地平（西尼地平组），而另外18例患者（58±3岁）继续服用原处方的钙通道阻滞剂（对照组）。在基线期和随访6个月后进行24小时尿收集。西尼地平组和对照组的基线特征，包括年龄、血压水平、体重指数和肌酐清除率相似。西尼地平组（0.61±0.10 g/天）和对照组（0.86±0.17 g/天）的尿蛋白排泄也相当。西尼地平组6个月后尿蛋白显著降低（-0.21±0.11 g/天，-36%，p<0.01），而对照组未变化（+0.01±0.15 g/天，0.4%，无统计学意义）。两组随访期间血压、血清肌酐、肌酐清除率、估计蛋白质摄入量和尿盐排泄均无显著变化。西尼地平降低尿蛋白的作用在原发性高血压患者中明显（-54±9%，n=18，p<0.01），而在肾性高血压患者中不明显（+10±35%，n=7，无统计学意义）。结果表明，西尼地平具有抗蛋白尿作用，尤其在原发性高血压患者中。
