Omata K, Kanazawa M, Sato T, Abe F, Saito T, Abe K
Second Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan.
Kidney Int Suppl. 1996 Jun;55:S57-62.
More than other drugs, angiotension converting enzyme (ACE) inhibitors have been shown to provide better control of glomerular hypertension and improved preservation of renal function. Long-term treatment with captopril slows the progression of renal impairment in diabetic nephropathy; however, the data are inconclusive for non-diabetic nephropathies. ACE inhibitors such as captopril, enalapril, alacepril delapril cilazapril, and lisinopril were equally effective in reducing blood pressure in multicenter clinical trials focusing on renal hypertension in Japan. We studied the influence of ambulatory blood pressure (ABP) and the effects of hypertension therapy in 104 patients with chronic renal glomerulonephritis as diagnosed by renal biopsy. Patients were subdivided into hypertensive, normotensive and hypotensive groups according to ABP and ages. Hypotensive subjects showed an improvement, while normotensive subjects showed a slower rate of progression of renal function loss than hypertensive patients. This suggests that the adequate ABP levels were 100 to 125/55 to 75 in those who were less than 40 years old, 100 to 135/60 to 80 mm Hg in patients aged 40 to 60, and 105 to 140/60 to 85 mm Hg in those over 60 years old. The renal protective effects of calcium antagonists and ACE inhibitors were associated with a reduction in blood pressure, but not with the hypotensive action.
与其他药物相比，血管紧张素转换酶（ACE）抑制剂已被证明能更好地控制肾小球高血压并改善肾功能。卡托普利长期治疗可减缓糖尿病肾病患者肾功能损害的进展；然而，对于非糖尿病肾病，数据尚无定论。在日本针对肾性高血压的多中心临床试验中，卡托普利、依那普利、阿拉普利、地拉普利、西拉普利和赖诺普利等ACE抑制剂在降低血压方面同样有效。我们研究了104例经肾活检确诊为慢性肾小球肾炎患者的动态血压（ABP）影响及高血压治疗效果。根据ABP和年龄分为高血压组、血压正常组和低血压组。低血压患者病情有所改善，而血压正常的患者肾功能丧失进展速度比高血压患者慢。这表明，40岁以下患者的合适ABP水平为100至125/55至75，40至60岁患者为100至135/60至80 mmHg，60岁以上患者为105至140/60至85 mmHg。钙拮抗剂和ACE抑制剂的肾脏保护作用与血压降低有关，但与降压作用无关。
