Hatta T, Takeda K, Shiotsu Y, Sugishita C, Adachi T, Kimura T, Sonomura K, Kusaba T, Kishimioto N, Narumiya H, Tanda S, Tamagaki K, Yamada K, Kameyama H, Kido H, Harada S, Bito Y, Moriguchi J, Morimoto S, Okigaki M, Itoh H, Mori Y, Nakata T, Maki K, Sasaki S, Sawada K, Matsubara H
Department of Medicine, Division of Hypertension and Nephrology, Omihachiman Community Medical Centre, 1379 Tsuchida-cho, Omihachiman City, Shiga 523-0082, Japan.
J Int Med Res. 2012;40(4):1417-28. doi: 10.1177/147323001204000420.
This open-label, randomized controlled trial investigated the effects of cilnidipine, an L/N-type calcium channel blocker (CCB), in patients with chronic kidney disease (CKD).
Sixty patients with CKD and well-controlled hypertension being treated with a renin- angiotensin system (RAS) inhibitor and an L-type CCB (L-CCB) were randomly assigned either to switch from the L-CCB to cilnidipine after a 4-week observation period or to continue with L-CCB treatment. Blood pressure, heart rate and renal function were monitored for 12 months. Data were available for analysis from 50 patients: 24 from the cilnidipine group and 26 from the L-CCB group.
Blood pressure was well controlled in both groups. After 12 months, proteinuria and heart rate were significantly decreased in the cilnidipine group, but proteinuria increased and heart rate remained unchanged in the L-CCB group. There was a significant positive correlation between the percentage changes in proteinuria and heart rate.
Cilnidipine has antihypertensive effects equivalent to those of L-CCBs. In patients with CKD, proteinuria can be decreased by switching from an L-CCB to cilnidipine, thereby improving renal function.
本开放标签随机对照试验研究了L/N型钙通道阻滞剂（CCB）西尼地平对慢性肾脏病（CKD）患者的影响。
60例接受肾素-血管紧张素系统（RAS）抑制剂和L型CCB（L-CCB）治疗且高血压控制良好的CKD患者，在4周观察期后，随机分为两组，一组从L-CCB换用西尼地平，另一组继续L-CCB治疗。监测血压、心率和肾功能12个月。50例患者的数据可供分析：西尼地平组24例，L-CCB组26例。
两组血压均得到良好控制。12个月后，西尼地平组蛋白尿和心率显著降低，而L-CCB组蛋白尿增加且心率未变。蛋白尿和心率的变化百分比之间存在显著正相关。
西尼地平具有与L-CCB相当的降压作用。在CKD患者中，从L-CCB换用西尼地平可降低蛋白尿，从而改善肾功能。
