Ptinopoulou Anastasia G, Pikilidou Maria I, Tziolas Ioannis M, Haidich Anna-Bettina, Mark Patrick B, Zebekakis Pantelis E, Lasaridis Anastasios N
Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK.
Iran J Kidney Dis. 2017 May;11(3):192-200.
Hypertension has been identified as one of the commonest modifiable determinants for chronic kidney disease progression. A variety of antihypertensive drugs are available and their effect on kidney function has been investigated by a large number of randomized controlled trials. Observational studies, although scarcely been used, outpatient can reflect everyday practice, where drug exposures vary over time, and may provide an alternative for detecting longitudinal changes in kidney function.
We applied mixed model repeated measures analysis to investigate the effect of antihypertensive drug categories and their combinations on kidney function change over time in a cohort of 779 patients with essential hypertension, using the data from a Greek hypertension outpatient clinic. Antihypertensive drugs were grouped in 5 categories. Their effect was evaluated and their combinations with and without renin-angiotensin-system inhibitors (RASI) to each other. In addition, the combination of RASI with calcium channel blockers (CCBs) was studied.
Diuretics, RASI, CCBs, and beta-blockers had a significant renoprotective and blood pressure lowering effect. Combinations with RASI had a smaller beneficial effect on kidney function compared to CCBs (0.75 mL/min/1.73 m2 per year of drug use versus 0.97 mL/min/1.73 m2). There was no additional effect when combining RASI with CCBs. However, the lowering effect on systolic blood pressure was greater (-0.83 mm Hg per year of drug use, P < .001).
RASI were found to have a smaller, although significant, renoprotective effect. There was no additional effect on kidney function when combining RASI with CCBs.
高血压已被确认为慢性肾脏病进展最常见的可改变决定因素之一。有多种抗高血压药物可供使用，大量随机对照试验已对它们对肾功能的影响进行了研究。观察性研究虽然很少被采用，但门诊患者能反映日常实践情况，在这种情况下药物暴露随时间变化，可能为检测肾功能的纵向变化提供一种替代方法。
我们应用混合模型重复测量分析，利用希腊高血压门诊的数据，研究779例原发性高血压患者队列中抗高血压药物类别及其组合对肾功能随时间变化的影响。抗高血压药物分为5类。评估了它们的效果以及它们相互之间联合使用和不联合使用肾素 - 血管紧张素系统抑制剂（RASI）的情况。此外，还研究了RASI与钙通道阻滞剂（CCB）的联合使用情况。
利尿剂、RASI、CCB和β受体阻滞剂具有显著的肾脏保护和降压作用。与CCB相比，联合使用RASI对肾功能的有益作用较小（每年用药0.75 mL/min/1.73 m² 对比0.97 mL/min/1.73 m²）。RASI与CCB联合使用时没有额外效果。然而，对收缩压的降低作用更大（每年用药降低0.83 mmHg，P <.001）。
发现RASI具有较小但显著的肾脏保护作用。RASI与CCB联合使用时对肾功能没有额外效果。
