Simon G, Morioka S, Snyder D K, Cohn J N
Clin Pharmacol Ther. 1983 Oct;34(4):459-65. doi: 10.1038/clpt.1983.198.
The renal effects of long-term antihypertensive treatment with enalapril were evaluated in 34 subjects (age, 53 yr; range, 27 to 65) with mild, uncomplicated hypertension. After receiving placebo for 4 wk, subjects were randomly assigned to groups receiving incremental doses of enalapril (10, 20, or 40 mg/day for 4 wk each) in a single morning dose or two divided doses, or of placebo. One subject who received enalapril developed acute renal failure by the end of the study. There was no evidence of glomerular or tubular damage in the other subjects; as measured by 24-hr urinary protein excretion, urinary activity of N-acetyl-beta-D-glucosaminidase, and uric acid clearance. During treatment with enalapril, renal plasma flow (measured with 131I-iodohippurate sodium) and glomerular filtration rate increased by 12.1% and 6.8%. Changes in renal plasma flow correlated inversely with age and final mean arterial pressure and correlated positively with initial plasma renin activity of subjects. Except for an occasional idiosyncratic adverse reaction, enalapril is a safe and effective antihypertensive drug with the unique ability to increase renal function despite a fall in renal perfusion pressure.
在34名（年龄53岁，范围27至65岁）轻度、无并发症高血压患者中评估了依那普利长期降压治疗对肾脏的影响。在接受4周安慰剂治疗后，患者被随机分配至接受递增剂量依那普利（每天10、20或40毫克，各治疗4周）的组，依那普利采用单次晨起给药或分两次给药，或接受安慰剂治疗。一名接受依那普利治疗的患者在研究结束时出现急性肾衰竭。其他患者没有肾小球或肾小管损伤的证据；通过24小时尿蛋白排泄、N-乙酰-β-D-氨基葡萄糖苷酶的尿活性和尿酸清除率来衡量。在依那普利治疗期间，肾血浆流量（用131I-碘马尿酸钠测量）和肾小球滤过率分别增加了12.1%和6.8%。肾血浆流量的变化与年龄和最终平均动脉压呈负相关，与患者的初始血浆肾素活性呈正相关。除偶尔出现特异质性不良反应外，依那普利是一种安全有效的降压药物，具有在肾灌注压下降的情况下仍能增加肾功能的独特能力。
