Gansevoort R T, de Zeeuw D, Shahinfar S, Redfield A, de Jong P E
Department of Medicine, State University Hospital, Groningen, The Netherlands.
J Hypertens Suppl. 1994 Jul;12(2):S37-42.
To study the effects of the angiotensin II antagonist losartan in hypertensive patients with renal disease.
A single-blind longitudinal study was performed, lasting 4 months. Patients were treated once a day with placebo, 50 mg losartan, 100 mg losartan and placebo, each for 1 month, in sequence. Measurements were taken at the end of each treatment period.
The study subjects comprised 13 patients with biopsy-proven renal disease, a diastolic blood pressure of > 90 mmHg, creatinine clearance of > 60 ml/min and stable proteinuria of > 2.0 g/day.
Mean arterial pressure, measured 4 h after the dose, fell from 113.8 +/- 2.1 mmHg (placebo) to 99.2 +/- 2.4 mmHg (50-mg dose) and 96.5 +/- 2.4 mmHg (100-mg dose). This blood pressure lowering effect was sustained for 24 h 116.3 +/- 2.3 mmHg (placebo) versus 105.5 +/- 1.8 mmHg (50-mg dose) and 103.3 +/- 1.9 mmHg (100-mg dose)]. The glomerular filtration rate remained stable, while the effective renal plasma flow increased by 12.5 +/- 2.9% (100-mg dose). The systemic and renal hemodynamic effects were similar at the 50- and 100-mg doses. Urinary excretion of total protein, albumin and immunoglobulin G decreased dose-dependently by a maximum of +/- 50% (100-mg dose). With the high dose, serum uric acid fell from 0.43 +/- 0.02 mmol/l to 0.39 +/- 0.02 mmol/l, and potassium increased from 4.2 +/- 0.1 to 4.6 +/- 0.1 mmol/l.
The angiotensin II antagonist losartan lowers blood pressure and displays a favorable renal profile in hypertensive patients with renal disease.
研究血管紧张素II拮抗剂氯沙坦对肾病高血压患者的影响。
进行了一项为期4个月的单盲纵向研究。患者依次每天接受一次安慰剂、50毫克氯沙坦、100毫克氯沙坦和安慰剂治疗，每种治疗持续1个月。在每个治疗期结束时进行测量。
研究对象包括13例经活检证实患有肾病、舒张压>90 mmHg、肌酐清除率>60 ml/分钟且稳定蛋白尿>2.0 g/天的患者。
给药4小时后测量的平均动脉压从113.8±2.1 mmHg（安慰剂）降至99.2±2.4 mmHg（50毫克剂量）和96.5±2.4 mmHg（100毫克剂量）。这种降压作用持续24小时[116.3±2.3 mmHg（安慰剂）对105.5±1.8 mmHg（50毫克剂量）和103.3±1.9 mmHg（100毫克剂量）]。肾小球滤过率保持稳定，而有效肾血浆流量增加了12.5±2.9%（100毫克剂量）。50毫克和100毫克剂量时的全身和肾脏血流动力学效应相似。总蛋白、白蛋白和免疫球蛋白G的尿排泄量剂量依赖性降低，最大降低幅度为±50%（100毫克剂量）。高剂量时，血清尿酸从0.43±0.02 mmol/l降至0.39±0.02 mmol/l，钾从4.2±0.1 mmol/l增加至4.6±0.1 mmol/l。
血管紧张素II拮抗剂氯沙坦可降低血压，并在肾病高血压患者中显示出良好的肾脏特征。
