Galceran Josep, Plana Jaume, Felip Angela, Pou Gabriel, Vila Joaquim, Sobrino Javier
Nephrology Department, Althaia Foundation, Flor de Lis 33, 08242 Manresa, Spain.
Expert Rev Cardiovasc Ther. 2010 Jun;8(6):751-7. doi: 10.1586/erc.10.48.
Microalbuminuria is an issue of great concern in hypertensive patients owing to its close relation with cardiovascular morbidity and mortality. Treatment should aim to reduce microalbuminuria to the normal range. Drugs that block the renin-angiotensin system have specific antiproteinuric properties, but more than one drug is needed to achieve blood pressure control in most cases. The aim of this study was to compare the effects of adding manidipine to the treatment of patients with essential hypertension and persistent albuminuria, despite full-dose treatment with a renin-angiotensin system blocker on urinary albumin excretion (UAE) after 24 weeks of therapy. Patients with diabetes and renal insufficiency were excluded. At baseline, blood pressure and UAE were 155.1 +/- 12/87.76 +/- 11 mmHg and 293.19 +/- 285 mg/g, respectively. At study end, blood pressure was 137.1 +/- 13.1/77.24 +/- 10.4 mmHg (p < 0.001 vs baseline). UAE was reduced by 45% to 161.52 +/- 163 mg/g (p < 0.001 vs baseline). No correlations were found between systolic blood pressure reduction and UAE reduction (Pearson's R = -0.034; p = not significant) nor between estimated glomerular filtration rate and UAE reduction (Pearson's R = -0.0056; p = not significant). No patient withdrew from the study owing to side effects. In conclusion, treatment with manidipine resulted in a large reduction in UAE rates, and this reduction appeared to be independent of the degree of blood pressure reduction or changes in estimated glomerular filtration rate. Our data supports the added value of manidipine in the treatment of patients with hypertension and microalbuminuria.
微量白蛋白尿在高血压患者中是一个备受关注的问题，因为它与心血管疾病的发病率和死亡率密切相关。治疗应旨在将微量白蛋白尿降低至正常范围。阻断肾素 - 血管紧张素系统的药物具有特定的抗蛋白尿特性，但在大多数情况下需要不止一种药物来控制血压。本研究的目的是比较在接受肾素 - 血管紧张素系统阻滞剂全剂量治疗后仍有持续性白蛋白尿的原发性高血压患者中，加用马尼地平治疗24周后对尿白蛋白排泄量（UAE）的影响。排除患有糖尿病和肾功能不全的患者。基线时，血压和UAE分别为155.1±12/87.76±11 mmHg和293.19±285 mg/g。研究结束时，血压为137.1±13.1/77.24±10.4 mmHg（与基线相比，p<0.001）。UAE降低了45%，降至161.52±163 mg/g（与基线相比，p<0.001）。未发现收缩压降低与UAE降低之间存在相关性（Pearson相关系数R = -0.034；p =无统计学意义），估计肾小球滤过率与UAE降低之间也无相关性（Pearson相关系数R = -0.0056；p =无统计学意义）。没有患者因副作用退出研究。总之，马尼地平治疗导致UAE率大幅降低，且这种降低似乎与血压降低程度或估计肾小球滤过率的变化无关。我们的数据支持马尼地平在高血压和微量白蛋白尿患者治疗中的附加价值。
