Kario Kazuomi, Matsui Yoshio, Shibasaki Seiichi, Eguchi Kazuo, Ishikawa Joji, Hoshide Satoshi, Ishikawa Shizukiyo, Kabutoya Tomoyuki, Schwartz Joseph E, Pickering Thomas G, Shimada Kazuyuki
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
J Hypertens. 2008 Jun;26(6):1257-65. doi: 10.1097/HJH.0b013e3282fd173c.
The impact on microalbuminuria of strict treatment aimed at lowering of self-measured morning blood pressure using an adrenergic blockade is unclear.
We conducted an open-label multicenter trial, the Japan Morning Surge-1 Study, that enrolled 611 hypertensive patients, whose self-measured morning systolic blood pressure levels were more than 135 mmHg while taking antihypertensive drugs. These were randomly allocated to an experimental group, whose members received bedtime administration of 1-4 mg doxazosin (doxazosin group) or a control group whose members continued without any add-on medication (control group). The urinary albumin/creatinine ratio was investigated at the baseline and 6 months after the randomization.
Both the morning and evening blood pressures and urinary albumin/creatinine ratio (-3.4 vs. 0.0 mg/gCr for urinary albumin/creatinine ratio; P < 0.001) were more markedly reduced in the doxazosin group than in the control group. This difference in the urinary albumin/creatinine ratio between the two groups was more marked in the patients with microalbuminuria (n = 238, -27.9 vs. -8.1 mg/gCr, P < 0.001). The reduction of urinary albumin/creatinine ratio was significantly associated with the use of doxazosin, and the change in all self-measured blood pressures (morning, evening, the average morning-evening), and these associations were independent of each other (P < 0.001).
Adding a bedtime dose of an alpha-adrenergic blocker titrated by self-measured morning blood pressure in treated hypertensive patients with uncontrolled morning hypertension significantly reduced blood pressure and urinary albumin excretion rate, particularly in those with microalbuminuria.
旨在通过肾上腺素能阻滞剂降低自测晨起血压的严格治疗对微量白蛋白尿的影响尚不清楚。
我们开展了一项开放标签的多中心试验，即日本晨起血压高峰-1研究，纳入了611例高血压患者，这些患者在服用抗高血压药物时自测晨起收缩压水平超过135 mmHg。将他们随机分配至试验组，试验组患者睡前服用1 - 4 mg多沙唑嗪（多沙唑嗪组），或分配至对照组，对照组患者继续不添加任何额外药物（对照组）。在基线和随机分组后6个月时对尿白蛋白/肌酐比值进行研究。
多沙唑嗪组的晨起和夜间血压以及尿白蛋白/肌酐比值（尿白蛋白/肌酐比值为-3.4 vs. 0.0 mg/gCr；P < 0.001）均比对照组有更显著的降低。两组之间尿白蛋白/肌酐比值的差异在微量白蛋白尿患者中（n = 238，-27.9 vs. -8.1 mg/gCr，P < 0.001）更为明显。尿白蛋白/肌酐比值的降低与多沙唑嗪的使用以及所有自测血压（晨起、夜间、晨起-夜间平均值）的变化显著相关，并且这些关联相互独立（P < 0.001）。
在晨起高血压未得到控制的接受治疗的高血压患者中，睡前加用一剂根据自测晨起血压滴定的α-肾上腺素能阻滞剂可显著降低血压和尿白蛋白排泄率，尤其是在微量白蛋白尿患者中。
