Tanaka M
Department of Endocrinology, Tenri Hospital, Tenri, Nara, Japan.
J Int Med Res. 2010 Mar-Apr;38(2):602-10. doi: 10.1177/147323001003800222.
This study was designed to investigate whether the L/N-type calcium channel blocker, cilnidipine, had a renoprotective effect compared with other calcium channel blockers. Twenty-five hypertensive patients with concomitant type 2 diabetes who had a urinary albumin-creatinine ratio (ACR) of 10 - 300 mg albumin/g creatinine and who had been treated with oral calcium channel blockers other than cilnidipine for more than 3 months were included. Patients' medication was changed to cilnidipine 10 mg/day or 20 mg/day without a washout period. Blood pressure and renal function were measured before and at 3 months after the new treatment. Heart rate was also determined as a marker for sympathetic nervous activity. After substitution of cilnidipine, blood pressure did not change significantly, but heart rate decreased significantly from 73.9 +/- 7.1 beats/min to 72.0 +/- 8.4 beats/min, and the log-transformed urinary ACR decreased to 82.9 +/- 49.4% of baseline values. The changes in urinary ACR and heart rate showed a significant positive correlation. Thus, there was a strong indication that cilnidipine may exert its renoprotective effect by inhibiting sympathetic nervous activity.
本研究旨在调查与其他钙通道阻滞剂相比，L/N型钙通道阻滞剂西尼地平是否具有肾脏保护作用。纳入了25例伴有2型糖尿病的高血压患者，这些患者的尿白蛋白肌酐比值（ACR）为10 - 300mg白蛋白/ g肌酐，并且接受非西尼地平的口服钙通道阻滞剂治疗超过3个月。患者的药物治疗改为西尼地平10mg/天或20mg/天，无需洗脱期。在新治疗前及治疗3个月后测量血压和肾功能。心率也作为交感神经活动的标志物进行测定。更换为西尼地平后，血压无显著变化，但心率从73.9±7.1次/分钟显著降至72.0±8.4次/分钟，且经对数转换的尿ACR降至基线值的82.9±49.4%。尿ACR和心率的变化呈显著正相关。因此，有强有力的迹象表明，西尼地平可能通过抑制交感神经活动发挥其肾脏保护作用。
