Takami Takeshi, Okada Sadanori, Saito Yoshihiko, Nishijima Yoko, Kobori Hiroyuki, Nishiyama Akira
Department of Internal Medicine, Clinic Jingumae, Kashihara, Japan.
Department of Cardiovascular Medicine, Nara medical University, Kashihara, Japan.
World J Res Rev. 2018 Jan;6(1):7-10.
Olmesartan and azilsartan decrease blood pressure more effectively than other angiotensin receptor blockers (ARBs). ARBs additionally decrease the urinary albumin to creatinine ratio (UACR), a urinary albumin marker, and urinary angiotensinogen (u-AGT), an intrarenal renin-angiotensin system activity marker. We examined the effects of these ARBs on blood pressure, UACR, and u-AGT in patients with uncontrolled hypertension.
Patients with uncontrolled hypertension treated with conventional ARBs, excluding olmesartan and azilsartan, for over 8 weeks were enrolled. We randomly switched patients from their prior ARBs to either olmesartan or azilsartan, and followed them for 24 weeks.
Systolic blood pressure (SBP), diastolic blood pressure (DBP), and central systolic blood pressure (cSBP) significantly decreased at 24 weeks. UACR and u-AGT also decreased at 24 weeks in both groups. There were no significant differences in SBP, DBP, cSBP, UACR, or u-AGT between the groups. Therefore, we combined both groups for further analyses. After combining, SBP (160.5 ± 16.4 to 139.6 ± 15.6 mm Hg, P < 0.0001), DBP (88.4 ± 13.7 to 80.7 ± 13.2 mm Hg, P = 0.008), cSBP (167.4 ± 20.8 to 146.6 ± 24.6 mm Hg, P < 0.0001), UACR (13.8 to 9.0 mg/g Cre, P = 0.0096), and u-AGT (4.13 to 2.32 μg/g Cre, P = 0.0074) significantly decreased at 24 weeks. Patients with microalbuminuria (UACR ≥ 30 mg/g Cre) had significantly greater ΔUACR (-39.4 vs 0.27, P = 0.0024) and Δu-AGT (-11.9 vs -0.61, P = 0.0235) than patients without microalbuminuria. The changes in u-AGT were significantly associated with changes in UACR (r = 0.411, P = 0.046); however, there was no significant relationship between the changes in u-AGT and those in SBP or DBP.
Olmesartan and azilsartan decreased blood pressure, UACR, and u-AGT more than the other ARBs, and exerted depressor and renoprotective effects.
奥美沙坦和阿齐沙坦在降低血压方面比其他血管紧张素受体阻滞剂（ARB）更有效。ARB还能降低尿白蛋白与肌酐比值（UACR，一种尿白蛋白标志物）以及尿血管紧张素原（u-AGT，一种肾内肾素-血管紧张素系统活性标志物）。我们研究了这些ARB对血压未得到控制的高血压患者的血压、UACR和u-AGT的影响。
纳入接受常规ARB（不包括奥美沙坦和阿齐沙坦）治疗超过8周但血压未得到控制的患者。我们将患者从之前使用的ARB随机换用为奥美沙坦或阿齐沙坦，并对他们进行24周的随访。
24周时收缩压（SBP）、舒张压（DBP）和中心收缩压（cSBP）显著降低。两组患者在24周时UACR和u-AGT也均降低。两组之间的SBP、DBP、cSBP、UACR或u-AGT无显著差异。因此，我们将两组合并进行进一步分析。合并后，24周时SBP（从160.5±16.4降至139.6±15.6 mmHg，P<0.0001）、DBP（从88.4±13.7降至80.7±13.2 mmHg，P = 0.008）、cSBP（从167.4±20.8降至146.6±24.6 mmHg，P<0.0001）、UACR（从13.8降至9.0 mg/g Cre，P = 0.0096）和u-AGT（从4.13降至2.32 μg/g Cre，P = 0.0074）均显著降低。微量白蛋白尿（UACR≥30 mg/g Cre）患者的ΔUACR（-39.4 vs 0.27，P = 0.0024）和Δu-AGT（-11.9 vs -0.61，P = 0.0235）显著大于无微量白蛋白尿的患者。u-AGT的变化与UACR的变化显著相关（r = 0.411，P = 0.046）；然而，u-AGT的变化与SBP或DBP的变化之间无显著关系。
与其他ARB相比，奥美沙坦和阿齐沙坦在降低血压、UACR和u-AGT方面更有效，并具有降压和肾脏保护作用。
