Ishii Takeo, Kawamura Tetsuya, Tsuboi Nobuo, Hosoya Tatsuo
Department of Nephrology and Hypertension, Jikei University School of Medicine, Tokyo, Japan.
Nihon Jinzo Gakkai Shi. 2010;52(7):945-51.
To evaluate whether a dose increase in angiotensin II receptor blocker (ARB) or in calcium channel blocker (CCB) is useful for chronic kidney disease (CKD) patients who do not reach their target blood pressure with ARB/CCB combined therapy.
The antihypertensive effect and the influence on the renal function were compared by 12 weeks each of a valsartan (VAL) dose uptitration period (VAL 160 mg + NCR 20 mg) and a nifedipine CR (NCR) dose uptitration period(VAL 80 mg+NCR 40 mg) using a crossover method in 31 CKD patients whose blood pressure did not reach the targeted BP with combined therapy with the standard dose of VAL 80 mg and NCR 20 mg.
The office SBP and early morning SBP at 12 weeks after the dose uptitration of NCR were significantly lower than the values at 12 weeks after the dose uptitration of VAL. The proportion of patients who achieved the targeted BP during the dose uptitration period of NCR was higher compared with that during the dose uptitration period of VAL. The urinary albumin excretion (UAE) reduced significantly during the dose titration period of NCR. However, the reduction of UAE was not significant during the dose uptitration period of VAL. The change in eGFR was not observed during either of the dose uptitration periods compared with the baseline. Significant correlation between the morning BP and UAE was observed during the dose titration period of NCR. On the other hand, the correlation was not observed during the VAL titration period.
In hypertensive patients with CKD who do not achieve their target BP with ARB/CCB combined therapy, a dose increase of CCB would be preferable to that of ARB from the viewpoint of strict control of BP and renal protection.
评估血管紧张素 II 受体阻滞剂（ARB）或钙通道阻滞剂（CCB）剂量增加对采用 ARB/CCB 联合治疗但未达到目标血压的慢性肾脏病（CKD）患者是否有用。
采用交叉法，对 31 例使用标准剂量缬沙坦（VAL）80 mg 和硝苯地平控释片（NCR）20 mg 联合治疗血压未达目标血压的 CKD 患者，分别进行 12 周的缬沙坦剂量滴定期（VAL 160 mg + NCR 20 mg）和硝苯地平控释片剂量滴定期（VAL 80 mg + NCR 40 mg），比较降压效果及对肾功能的影响。
硝苯地平控释片剂量滴定后 12 周的诊室收缩压和清晨收缩压显著低于缬沙坦剂量滴定后 12 周的值。硝苯地平控释片剂量滴定期达到目标血压的患者比例高于缬沙坦剂量滴定期。硝苯地平控释片剂量滴定期尿白蛋白排泄量（UAE）显著降低。然而，缬沙坦剂量滴定期 UAE 的降低不显著。与基线相比，两个剂量滴定期均未观察到估算肾小球滤过率（eGFR）的变化。硝苯地平控释片剂量滴定期观察到清晨血压与 UAE 之间存在显著相关性。另一方面，缬沙坦滴定期未观察到相关性。
在采用 ARB/CCB 联合治疗未达到目标血压的 CKD 高血压患者中，从严格控制血压和肾脏保护的角度来看，增加 CCB 剂量比增加 ARB 剂量更可取。
