Cátedra de Riesgo Cardiovascular, Universidad de Salamanca, Servicio de Nefrología, Hospital Infanta Cristina, Badajoz, Spain.
Ren Fail. 2010 Jan;32(2):192-7. doi: 10.3109/08860220903541135.
Most calcium antagonists do not seem to reduce microalbuminuria or proteinuria. We have tried to assess the antiproteinuric effect of a calcium channel blocker, lercanidipine, in patients previously treated with ACE inhibitors or angiotensin receptor blockers.
The study included 68 proteinuric (> 500 mg/day) patients (age 63.1 +/- 12.9 years, 69.1% males and 30.9 females). All patients were receiving ACE inhibitors (51.4%) or angiotensin II receptor blockers (48.6%) therapy but had higher blood pressure than recommended for proteinuric patients (<130/80 mmHg). Patients were clinically evaluated one, three, and six months after starting treatment with lercanidipine (20 mg/day). Samples for urine and blood examination were taken during the examination. When needed, a third drug was added to treatment. Creatinine clearance was measured using 24 h urine collection.
BP significantly decreases from 152 +/- 15/86 +/- 11 mmHg to 135 +/- 12/77 +/- 10 mmHg at six months of follow-up (p < 0.001). After six months of treatment, the percentage of normalized patients (BP < 130/80 mmHg) was 42.5%, and the proportion of patients whose BP was below 140/90 mmHg was 58.8%. Plasmatic creatinine did not change nor did creatinine clearance. Plasmatic cholesterol also decreased from 210 +/- 48 to 192 +/- 34 mg/dL (p < 0.001), as did plasma triglycerides (from 151 +/- 77 to 134 +/- 72 mg/dL, p = 0.022). Basal proteinuria was 1.63 +/- 1.34 g/day; it was significantly (p < 0.001) reduced by 23% at the first month, 37% at three months, and 33% at the last visit.
Lercanidipine at 20 mg dose, associated to renin-angiotensin axis-blocking drugs, showed a high antihypertensive and antiproteinuric effect. This antiproteinuric effect seems to be dose-dependent as compared with previous reports and proportionally higher than blood pressure reduction.
大多数钙拮抗剂似乎不能减少微量白蛋白尿或蛋白尿。我们曾试图评估钙通道阻滞剂勒卡地平在先前接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗的患者中的抗蛋白尿作用。
该研究纳入了 68 名蛋白尿（> 500mg/天）患者（年龄 63.1 ± 12.9 岁，69.1%为男性，30.9%为女性）。所有患者均接受血管紧张素转换酶抑制剂（51.4%）或血管紧张素 II 受体阻滞剂（48.6%）治疗，但血压高于蛋白尿患者的推荐值（< 130/80mmHg）。患者在开始服用勒卡地平（20mg/天）后 1、3 和 6 个月进行临床评估。检查期间采集尿液和血液检查样本。如有需要，可在治疗中添加第三种药物。使用 24 小时尿液收集测量肌酐清除率。
血压从治疗前的 152 ± 15/86 ± 11mmHg 显著下降至 6 个月随访时的 135 ± 12/77 ± 10mmHg（p < 0.001）。治疗 6 个月后，血压正常化患者（血压< 130/80mmHg）的比例为 42.5%，血压低于 140/90mmHg 的患者比例为 58.8%。血浆肌酐和肌酐清除率没有变化。血浆胆固醇也从 210 ± 48mg/dL 降至 192 ± 34mg/dL（p < 0.001），血浆甘油三酯也从 151 ± 77mg/dL 降至 134 ± 72mg/dL（p = 0.022）。基础蛋白尿为 1.63 ± 1.34g/天；第 1 个月时显著降低了 23%（p < 0.001），第 3 个月时降低了 37%，最后一次就诊时降低了 33%。
勒卡地平 20mg 剂量与肾素-血管紧张素轴阻断药物联合使用，具有较高的降压和抗蛋白尿作用。与以往报道相比，这种抗蛋白尿作用似乎呈剂量依赖性，与血压降低的比例相比，蛋白尿降低的比例更高。
