Okada Shuichi, Shibusawa Ryo, Tagaya Yuko, Saito Tsugumichi, Yamada Eijiro, Shimoda Yoko, Satoh Tetsurou, Okada Junichi, Yamada Masanobu
Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan.
J Med Case Rep. 2014 Dec 16;8:428. doi: 10.1186/1752-1947-8-428.
Animal studies have reported that treatment with angiotensin II receptor blockers reduced kidney sodium-dependent glucose cotransporter expression. We therefore hypothesized that patients with hypertension treated with an angiotensin II receptor blocker (candesartan) would probably have an increased response to sodium-dependent glucose cotransporter inhibitor therapy (ipragliflozin) compared with patients treated with alternative hypertensive medications such as calcium channel blockers (nifedipine). Although sodium-dependent glucose cotransporter inhibitor (ipragliflozin) is a new anti-diabetic medicine, the clinical efficacy in the Japanese population has not been fully evaluated. We compared the combined effect of angiotensin II receptor blocker candesartan plus ipragliflozin with nifedipine plus ipragliflozin therapy and found that the combination of candesartan plus ipragliflozin was more effective in increasing glycosuria and lowering plasma glucose.
A 57-year-old Japanese man with essential hypertension was treated with candesartan. Candesartan was switched to nifedipine for the initial 10 days of an observation period and 5 days later he was started on ipragliflozin (day 6 of nifedipine treatment) with nifedipine for the next 5 days. Thereafter (from day 11 to day 20), candesartan was started instead of nifedipine and ipragliflozin was continued. In the last 5 days ipragliflozin was stopped and he was treated with candesartan alone. Neither nifedipine alone (0.038+/-0.004) nor candesartan alone (0.048+/-0.006) produce any trace amount of glycosuria. However, the extent of glycosuria under ipragliflozin with candesartan treatment (37.5+/-8.45) was significantly greater than that of ipragliflozin with nifedipine (23.75+/-0.35; P<0.05).
Candesartan demonstrated additive actions with ipragliflozin to increase glycosuria compared to ipragliflozin with nifedipine treatment.
动物研究报告称，使用血管紧张素II受体阻滞剂治疗可降低肾脏中钠依赖性葡萄糖协同转运蛋白的表达。因此，我们推测，与接受其他降压药物（如钙通道阻滞剂硝苯地平）治疗的患者相比，接受血管紧张素II受体阻滞剂（坎地沙坦）治疗的高血压患者可能对钠依赖性葡萄糖协同转运蛋白抑制剂疗法（依帕列净）的反应更强。尽管钠依赖性葡萄糖协同转运蛋白抑制剂（依帕列净）是一种新型抗糖尿病药物，但其在日本人群中的临床疗效尚未得到充分评估。我们比较了血管紧张素II受体阻滞剂坎地沙坦加依帕列净与硝苯地平加依帕列净治疗的联合效果，发现坎地沙坦加依帕列净的联合用药在增加糖尿和降低血糖方面更有效。
一名57岁的日本男性原发性高血压患者接受了坎地沙坦治疗。在观察期的前10天，坎地沙坦换为硝苯地平，5天后（硝苯地平治疗第6天）开始使用依帕列净并继续使用硝苯地平5天。此后（从第11天到第20天），开始使用坎地沙坦替代硝苯地平并继续使用依帕列净。在最后5天，停用依帕列净，仅用坎地沙坦治疗。单独使用硝苯地平（0.038±0.004）或单独使用坎地沙坦（0.048±0.006）均未产生任何微量糖尿。然而，坎地沙坦联合依帕列净治疗时的糖尿程度（37.5±8.45）显著高于硝苯地平联合依帕列净时的糖尿程度（23.75±0.35；P<0.05）。
与硝苯地平联合依帕列净治疗相比，坎地沙坦与依帕列净联合使用可增加糖尿，表现出相加作用。
