Saito Fumio, Fujita Hirotaka, Takahashi Atsuhiko, Ichiyama Izumi, Harasawa Shinsuke, Oiwa Kouji, Takahashi Naoyuki, Otsuka Yuji, Uchiyama Takashi, Kanmatsuse Katsuo, Kushiro Toshio
Department of Cardiology, Nihon University Surugadai Hospital, Tokyo, Japan.
Hypertens Res. 2007 Jan;30(1):39-47. doi: 10.1291/hypres.30.39.
In hypertensive patients with chronic renal disease, angiotensin receptor blockers (ARBs) are among the first-line drugs, and calcium channel blockers (CCBs) are recommended as a second line. We examined the effects of two therapeutic strategies using ARBs and benidipine, a CCB, on blood pressure (BP), urinary albumin excretion (UAE), and cost-effectiveness in hypertensive patients with albuminuria. Patients whose BP was 140/90 mmHg or higher despite treatment with low- or medium-dose ARBs were assigned randomly to two groups. In Group A (n=14), the ARB dose was maximized and then benidipine was added until BP targets were reached (<130/85 mmHg). In Group B (n=18), benidipine was administered first and then the ARB dose was increased until BP targets were reached. The BP targets were achieved by ARB alone in 36% of Group A patients and by the addition of benidipine in 83% of Group B patients. Finally, BP decreased in each group, reaching the targets in 93% of Group A patients and 94% of Group B patients after a 4-month therapeutic period. UAE was decreased in both groups after a 4-month therapeutic period compared to the allocation period (-33+/-6% in Group A, -31+/-6% in Group B; p<0.001, respectively). The monthly drug cost was higher (11,426+/-880 vs. 8,955+/-410 yen, p=0.012) and the cost-effectiveness of antihypertensive treatment was lower (p=0.003) in Group A than in Group B. We conclude that the addition of benidipine to low- or medium-dose ARB is, in light of the renal protection and the cost-effectiveness of this approach, a useful therapeutic strategy for controlling BP in hypertensive patients with albuminuria.
在患有慢性肾病的高血压患者中，血管紧张素受体阻滞剂（ARB）属于一线药物，而钙通道阻滞剂（CCB）被推荐作为二线药物。我们研究了使用ARB和CCB类药物贝尼地平的两种治疗策略对蛋白尿性高血压患者的血压（BP）、尿白蛋白排泄量（UAE）以及成本效益的影响。尽管使用了低剂量或中等剂量的ARB进行治疗，但血压仍在140/90 mmHg或更高的患者被随机分为两组。A组（n = 14）先将ARB剂量增至最大，然后加用贝尼地平直至达到血压目标（<130/85 mmHg）。B组（n = 18）先使用贝尼地平，然后增加ARB剂量直至达到血压目标。A组36%的患者仅通过ARB就实现了血压目标，B组83%的患者通过加用贝尼地平实现了血压目标。最终，两组血压均下降，经过4个月的治疗期后，A组93%的患者和B组94%的患者达到了目标血压。与分配期相比，经过4个月治疗期后，两组的UAE均下降（A组为-33±6%，B组为-31±6%；p均<0.001）。A组的每月药物成本更高（11,426±880日元对8,955±410日元，p = 0.012），且降压治疗的成本效益更低（p = 0.003）。我们得出结论，鉴于这种方法对肾脏的保护作用和成本效益，在低剂量或中等剂量ARB基础上加用贝尼地平是控制蛋白尿性高血压患者血压的一种有效治疗策略。
