Kaneshiro Yuki, Ichihara Atsuhiro, Sakoda Mariyo, Kurauchi-Mito Asako, Kinouchi Kenichiro, Itoh Hiroshi
Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Kidney Blood Press Res. 2009;32(1):51-8. doi: 10.1159/000205521. Epub 2009 Mar 4.
Hypertension frequently requires combination therapy to attain efficient control to prevent cardiovascular diseases effectively. This study was conducted to determine which add-on treatment is better, namely calcium channel blockers or diuretics, in improving vascular damage. In 70 nondiabetic chronic kidney disease stage 1/2 patients who had been already treated with angiotensin II type 1 receptor blocker valsartan for at least 12 months, amlodipine or hydrochlorothiazide was added to their existing medication. Pulse wave velocity (PWV), intima-media thickness (IMT) of the carotid arteries, urinary albumin excretion (UAE), and 24-hour ambulatory blood pressure (BP) were determined before and 12 months after the start of add-on treatments. Add-on amlodipine and add-on hydrochlorothiazide significantly and similarly decreased 24-hour ambulatory BP by 18 and 19 mm Hg, respectively, PWV by 206 and 184 cm/s, respectively, and UAE, but did not change the IMT. The decreases in BP significantly contributed to the decreases in PWV and UAE and suggested that the decrease in serum cholesterol level brought about by add-on amlodipine also contributed to the decrease in UAE. These results suggest that 12 months of add-on treatment with either amlodipine or hydrochlorothiazide could have beneficial effects in nondiabetic chronic kidney disease stage 1/2 patients already being treated with valsartan.
高血压常常需要联合治疗才能有效控制，从而有效预防心血管疾病。本研究旨在确定哪种附加治疗更好，即钙通道阻滞剂还是利尿剂，在改善血管损伤方面。在70例非糖尿病慢性肾脏病1/2期患者中，这些患者已经接受血管紧张素II 1型受体阻滞剂缬沙坦治疗至少12个月，在其现有药物治疗基础上加用氨氯地平或氢氯噻嗪。在加用治疗开始前及开始后12个月测定脉搏波速度（PWV）、颈动脉内膜中层厚度（IMT）、尿白蛋白排泄率（UAE）和24小时动态血压（BP）。加用氨氯地平和加用氢氯噻嗪分别使24小时动态血压显著且相似地降低了18和19 mmHg，PWV分别降低了206和184 cm/s，并降低了UAE，但未改变IMT。血压的降低显著促成了PWV和UAE的降低，提示加用氨氯地平导致的血清胆固醇水平降低也促成了UAE的降低。这些结果表明，对于已经接受缬沙坦治疗的非糖尿病慢性肾脏病1/2期患者，加用氨氯地平或氢氯噻嗪进行12个月的治疗可能会产生有益效果。
