Nakano Nobuyuki, Ishimitsu Toshihiko, Takahashi Toshiaki, Inada Hideki, Okamura Atsushi, Ohba Shuichi, Matsuoka Hiroaki
Department of Hypertension and Cardiorenal Medicine, Dokkyo Medical University, Tochigi, Japan.
Int Heart J. 2010 May;51(3):188-92. doi: 10.1536/ihj.51.188.
Components of the renin-angiotensin-aldosterone system such as angiotensin II and aldosterone are believed to contribute to the development and progression of cardiovascular tissue and organ injuries. We compared the effects of two calcium channel blockers, efonidipine and amlodipine, on the renin-angiotensin-aldosterone system in patients with end-stage renal diseases on maintenance hemodialysis. Twenty hypertensive patients on chronic hemodialysis were given efonidipine 20-60 mg twice daily and amlodipine 2.5-7.5 mg once daily for 12 weeks each in a random crossover manner. The average blood pressure was comparable between the efonidipine and amlodipine periods (151 + or - 15/77 + or - 8 versus 153 + or - 15/76 + or - 8 mmHg). The pulse rate did not change significantly during the administration periods. Although the plasma renin activity and plasma angiotensin II were not significantly different between the efonidipine and amlodipine periods, plasma aldosterone was significantly lower in the efonidipine period than in the amlodipine period (123 + or - 118 versus 146 + or - 150 pg/mL, P = 0.027). The findings suggest that efonidipine reduces plasma aldosterone levels in patients on maintenance hemodialysis, and this seems to be an additional benefit to the cardiovascular protection by antihypertensive therapy with efonidipine in patients with end-stage renal disease.
肾素-血管紧张素-醛固酮系统的组成部分，如血管紧张素II和醛固酮，被认为与心血管组织和器官损伤的发生及进展有关。我们比较了两种钙通道阻滞剂，依福地平与氨氯地平，对维持性血液透析的终末期肾病患者肾素-血管紧张素-醛固酮系统的影响。20例慢性血液透析的高血压患者，以随机交叉方式，分别给予依福地平20 - 60毫克，每日两次，以及氨氯地平2.5 - 7.5毫克，每日一次，各治疗12周。依福地平治疗期与氨氯地平治疗期的平均血压相当（分别为151±15/77±8与153±15/76±8 mmHg）。给药期间脉搏率无显著变化。虽然依福地平治疗期与氨氯地平治疗期的血浆肾素活性及血浆血管紧张素II无显著差异，但依福地平治疗期的血浆醛固酮显著低于氨氯地平治疗期（分别为123±118与146±150 pg/mL，P = 0.027）。这些发现表明，依福地平可降低维持性血液透析患者的血浆醛固酮水平，这似乎是依福地平对终末期肾病患者进行抗高血压治疗时心血管保护的额外益处。
