Third Department of Internal Medicine, Fukui University School of Medicine, Japan.
Int J Cardiol. 2013 Jun 20;166(2):448-52. doi: 10.1016/j.ijcard.2011.10.133. Epub 2011 Nov 21.
At the intervention for cardiovascular disease (CVD), albuminuria is a new pivotal target. Calcium channel blocker (CCB) is one of the most expected agents. Currently CCBs have been classified by delivery system, half-life and channel types. We tested anti-albuminuric effect among 4 types of CCBs.
Subjects were 50 hypertensives (SBP/DBP 164.7±17.1/92.3±12.2mmHg, s-Cr 0.81±0.37mg/dl, urinary albumin excretion (UAE) 69.4 (33.5-142.6) mg/gCr). Four CCBs were administered in a crossover setting: nifedipine CR, a long biological half-life L type by controlled release; cilnidipine, an N/L type; efonidipine, a T/L type; and amlodipine, a long biological half-life L type.
Comparable BP reductions were obtained. UAE at endpoints ware as follows (mg/gCr, P<0.01): nifedipine CR 30.8 (17.3-81.1), cilnidipine 33.9 (18.0-67.7),* efonidipine 51.0 (21.2-129.8), amlodipine 40.6 (18.7-94.7). By all agents, significant augmentations were observed in PRA, angiotensin I and angiotensin II (AngII). AngII at cilnidipine was significantly lower than that at amlodipine. PAC at cilnidipine and efonidipine was significantly lower than that at amlodipine. Nifedipine CR significantly reduced ANP concentration.
It is revealed that only nifedipine CR and cilnidipine could reduce albuminuria statistically. Thus, it is suggested that the 2 CCBs might be favorable for organ protection in hypertensives.
在心血管疾病（CVD）的干预中，白蛋白尿是一个新的关键靶点。钙通道阻滞剂（CCB）是最有希望的药物之一。目前，CCB 已根据给药系统、半衰期和通道类型进行分类。我们测试了 4 种 CCB 对白蛋白尿的作用。
研究对象为 50 名高血压患者（SBP/DBP 为 164.7±17.1/92.3±12.2mmHg，s-Cr 为 0.81±0.37mg/dl，尿白蛋白排泄率（UAE）为 69.4（33.5-142.6）mg/gCr）。采用交叉设计给予 4 种 CCB：硝苯地平控释片，一种通过控制释放延长半衰期的 L 型；西尼地平，一种 N/L 型；依福地平，一种 T/L 型；氨氯地平，一种延长半衰期的 L 型。
各组患者的血压降低程度相当。终点时 UAE 如下（mg/gCr，*P<0.01）：硝苯地平控释片 30.8（17.3-81.1），*西尼地平 33.9（18.0-67.7），*依福地平 51.0（21.2-129.8），氨氯地平 40.6（18.7-94.7）。所有药物均显著增加肾素活性（PRA）、血管紧张素 I 和血管紧张素 II（AngII）。西尼地平的 AngII 水平显著低于氨氯地平。西尼地平和依福地平的 PAC 水平显著低于氨氯地平。硝苯地平控释片可显著降低 ANP 浓度。
结果表明，只有硝苯地平控释片和西尼地平可使白蛋白尿降低具有统计学意义。因此，提示这 2 种 CCB 可能对高血压患者的器官保护有益。
