Zanchi A, Brunner H R, Waeber B, Burnier M
Hypertension Division and Cardiovascular Research Group, University Hospital, Lausanne, Switzerland.
J Hypertens. 1995 Dec;13(12 Pt 1):1363-75.
In recent years, the ability of the various antihypertensive drugs to provide renal protection has been the subject of increased attention. Whether calcium antagonists prevent or reduce the rate of progression of renal damage is still a matter of controversy. This paper reviews the findings of recent animal and human studies on the haemodynamic and renal protective effects of calcium antagonists. These agents preferentially vasodilate afferent arterioles, leading to an increase in renal blood flow and glomerular filtration rate. These effects are more pronounced in hypertensive patients than in normotensive subjects and persist even when renal function is impaired. In animal models of chronic renal failure, calcium antagonists can reduce glomerulosclerosis. However, the mechanisms involved in their renal protective effect appear to be different from those of angiotensin converting enzyme (ACE) inhibitors as they do not reduce intraglomerular pressure. Renal failure caused by vasoconstriction related to radiocontrast agents or cyclosporine can be partly prevented by the administration of a calcium antagonist. Furthermore, in patients with renal artery stenosis, calcium antagonists reduce blood pressure with less renal blood flow impairment than ACE inhibitors. Preliminary clinical studies suggest that verapamil or diltiazem may reduce proteinuria in hypertensive diabetic patients. Whether these compounds can also retard the progression of renal failure in these patients remains to be established with larger trials.
近年来，各类抗高血压药物提供肾脏保护的能力受到了更多关注。钙拮抗剂能否预防或降低肾脏损害的进展速度仍是一个有争议的问题。本文综述了近期关于钙拮抗剂的血流动力学和肾脏保护作用的动物及人体研究结果。这些药物优先使入球小动脉血管舒张，导致肾血流量和肾小球滤过率增加。这些作用在高血压患者中比在血压正常者中更明显，即使肾功能受损时也依然存在。在慢性肾衰竭的动物模型中，钙拮抗剂可减轻肾小球硬化。然而，其肾脏保护作用的机制似乎与血管紧张素转换酶（ACE）抑制剂不同，因为它们不会降低肾小球内压力。与放射造影剂或环孢素相关的血管收缩所致的肾衰竭，可通过给予钙拮抗剂得到部分预防。此外，在肾动脉狭窄患者中，钙拮抗剂降低血压时对肾血流量的损害比ACE抑制剂小。初步临床研究表明，维拉帕米或地尔硫䓬可能降低高血压糖尿病患者的蛋白尿。这些化合物能否也延缓这些患者肾衰竭的进展仍有待通过更大规模的试验来确定。
