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氨氯地平对高血压慢性肾病患者的肾脏保护作用。

Reno protective role of amlodipine in patients with hypertensive chronic kidney disease.

作者信息

Abraham Georgi, Almeida A, Gaurav Kumar, Khan Mohammed Yunus, Patted Usha Rani, Kumaresan Maithrayie

机构信息

Department of Nephrology, MGM Healthcare, Nelson Manickam Road, Aminjikarai, Chennai 6300028, India.

PD Hinduja Hospital and Medical Research Center, Almeida, A (reprint author), PD Hinduja, Hinduja Clin, Dept Med, Nephrol Sect, 2209 Veer Savarkar Marg, Bombay 400016, Maharashtra, Mumbai 400016, India.

出版信息

World J Nephrol. 2022 May 25;11(3):86-95. doi: 10.5527/wjn.v11.i3.86.

Abstract

Chronic kidney disease (CKD) and hypertension (HTN) are closely associated with an overlapping and intermingled cause and effect relationship. Decline in renal functions are usually associated with a rise in blood pressure (BP), and prolonged elevations in BP hasten the progression of kidney function decline. Regulation of HTN by normalizing the BP in an individual, thereby slowing the progression of kidney disease and reducing the risk of cardiovascular disease, can be effectively achieved by the anti-hypertensive use of calcium channel blockers (CCBs). Use of dihydropyridine CCBs such as amlodipine (ALM) in patients with CKD is an attractive option not only for controlling BP but also for safely improving patient outcomes. Vast clinical experiences with its use as monotherapy and/or in combination with other anti-hypertensives in varied conditions have demonstrated its superior qualities in effectively managing HTN in patients with CKD with minimal adverse effects. In comparison to other counterparts, ALM displays robust reduction in risk of cardiovascular endpoints, particularly stroke, and in patients with renal impairment. ALM with its longer half-life displays effective BP control over 24-h, thereby reducing the progression of end-stage-renal disease. In conclusion, compared to other classes of CCBs, ALM is an attractive choice for effectively managing HTN in CKD patients and improving the overall quality of life.

摘要

慢性肾脏病(CKD)与高血压(HTN)密切相关,存在重叠且相互交织的因果关系。肾功能下降通常与血压(BP)升高相关,而血压长期升高会加速肾功能下降的进程。通过使用钙通道阻滞剂(CCB)进行降压治疗,使个体血压正常化,从而减缓肾病进展并降低心血管疾病风险,可有效实现对高血压的调控。在CKD患者中使用二氢吡啶类CCB,如氨氯地平(ALM),不仅是控制血压的理想选择,还能安全改善患者预后。在各种情况下将其作为单一疗法和/或与其他抗高血压药物联合使用的大量临床经验表明,它在有效管理CKD患者的高血压方面具有卓越品质,且副作用最小。与其他同类药物相比,ALM在降低心血管终点事件风险方面表现突出,尤其是中风,在肾功能损害患者中也是如此。半衰期较长的ALM能在24小时内有效控制血压,从而减缓终末期肾病的进展。总之,与其他类别的CCB相比,ALM是有效管理CKD患者高血压并提高整体生活质量的理想选择。

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