Widecka K, Celibała R, Czekalski S
Kliniki Endokrynologii, Nadciśnienia Tetniczego i Chorób Przemiany Materii Pomorskiej Akademii Medycznej w Szczecinie.
Pol Arch Med Wewn. 1995 Feb;93(2):135-42.
The purpose of the study was to compare the effect of treatment with an angiotensin converting enzyme inhibitor (Lisinopril, MSD) or calcium blocker (Nifedipine retard, MSD) treatment during three months on blood pressure (measured with sphygmomanometric method and ambulatory blood pressure monitoring--ABPM) and urinary albumin excretion in essential hypertension class I acc. to WHO. Fifteen untreated patients aged 38 +/- 5 years with essential hypertension participated in the study and received diet with normal sodium content. Urinary albumin excretion was measured by RIA method in two 24 hour urine collections and mean value was calculated. ABPM was measured with Spacelabs monitor. After first examination 8 patients were randomly selected for the treatment with lisinopril and 7 patients to the treatment with nifedipine. The doses of both drugs were gradually adjusted to reach diastolic blood pressure below 90 mmHg. After 3 months of treatment urinary albumin excretion and blood pressure was found in both after treatment in patients treated with lisinopril but not in those receiving nifedipine. In patients treated with lisinopril a correlation between the decrease in systolic and diastolic blood pressure (measured by ABPM) and decrease of urinary albumin excretion was demonstrated. It was concluded that the normalization of blood pressure induced by lisinopril treatment in patients with uncomplicated essential hypertension and normoalbuminuria is accompanied with significant diminution of urinary albumin excretion which suggests preventive action of the drug in the development of microalbuminuria. Diminution of urinary albumin excretion caused by lisinopril is probably due to both the decrease of blood pressure and the specific renal action of the drug.
本研究的目的是比较使用血管紧张素转换酶抑制剂（赖诺普利，默克雪兰诺公司）或钙通道阻滞剂（缓释硝苯地平，默克雪兰诺公司）治疗三个月对世界卫生组织定义的 I 级原发性高血压患者血压（采用血压计测量法和动态血压监测——ABPM）及尿白蛋白排泄的影响。15 名年龄为 38±5 岁的未经治疗的原发性高血压患者参与了本研究，并接受了正常钠含量的饮食。通过放射免疫分析法在两次 24 小时尿液收集样本中测量尿白蛋白排泄量，并计算平均值。使用太空实验室监测仪测量 ABPM。首次检查后，随机选择 8 名患者接受赖诺普利治疗，7 名患者接受硝苯地平治疗。逐渐调整两种药物的剂量，以使舒张压降至 90 mmHg 以下。治疗 3 个月后，发现接受赖诺普利治疗的患者治疗后尿白蛋白排泄和血压均有变化，而接受硝苯地平治疗的患者则未出现此情况。在接受赖诺普利治疗的患者中，收缩压和舒张压（通过 ABPM 测量）的降低与尿白蛋白排泄的减少之间存在相关性。得出的结论是，赖诺普利治疗使无并发症的原发性高血压和正常白蛋白尿患者的血压正常化的同时，尿白蛋白排泄量显著减少，这表明该药物对微量白蛋白尿的发生有预防作用。赖诺普利导致尿白蛋白排泄减少可能是由于血压降低以及该药物的特异性肾脏作用。
