Campo C, Garcia-Vallejo O, Barrios V, Lahera V, Manero M, Esteban E, Rodicio J L, Ruilope L M
Unidad de Hipertensión, Hospital 12 de Octubre, Madrid, Spain.
J Hypertens. 1997 Dec;15(12 Pt 2):1803-8. doi: 10.1097/00004872-199715120-00093.
Calcium channel blockers facilitate the renal excretion of sodium and this effect is maintained during chronic administration of these drugs. However, it is unknown whether this natriuretic effect remains despite the presence of a decreased renal function.
To compare the natriuretic capacity of nifedipine gastrointestinal therapeutic system (GITS) and lisinopril in patients with mild-to-moderate chronic renal failure.
An open-label, randomized, comparative study was conducted to compare the natriuretic capacity of nifedipine GITS and lisinopril in the presence of mild-to-moderate renal failure (creatinine clearance 30-80 ml/min). After a wash-out period of 4 weeks an intravenous saline infusion (30 ml/kg of body weight of isotonic saline in 4 h) was performed and repeated after 4 weeks of active therapy. Two sex- and age-matched groups of hypertensive patients (n = 25) were included in the study. Renal failure was diagnosed as secondary to nephrosclerosis in all the patients.
A significant increase in the renal capacity to excrete the sodium load was observed in patients receiving nifedipine GITS (n = 11) but not in those taking lisinopril (n = 13). Both drugs controlled blood pressure to a similar extent. No changes were observed in body weight, glomerular filtration rate and renal plasma flow (measured as inulin and paraaminohippurate clearances). A significant drop was observed in urinary albumin excretion after lisinopril, but not after nifedipine. Heart rate was higher in nifedipine group.
The natriuretic capacity of nifedipine GITS remains despite the presence of mild-to-moderate chronic renal failure. Such an effect takes place in the absence of changes in renal hemodynamics, suggesting that it is caused by a direct tubular effect.
钙通道阻滞剂可促进肾脏排钠，且在长期使用这些药物期间这种作用持续存在。然而，肾功能减退时这种利钠作用是否依然存在尚不清楚。
比较硝苯地平胃肠道治疗系统（GITS）与赖诺普利对轻至中度慢性肾衰竭患者的利钠能力。
进行了一项开放标签、随机、对照研究，以比较硝苯地平GITS和赖诺普利在轻至中度肾衰竭（肌酐清除率30 - 80 ml/min）患者中的利钠能力。经过4周的洗脱期后，静脉输注生理盐水（4小时内输注30 ml/kg体重的等渗盐水），并在4周积极治疗后重复进行。研究纳入了两组性别和年龄匹配的高血压患者（n = 25）。所有患者的肾衰竭均诊断为继发于肾硬化症。
接受硝苯地平GITS治疗的患者（n = 11）肾脏排泄钠负荷的能力显著增加，而服用赖诺普利的患者（n = 13）则未增加。两种药物对血压的控制程度相似。体重、肾小球滤过率和肾血浆流量（以菊粉和对氨基马尿酸清除率衡量）均未观察到变化。赖诺普利治疗后尿白蛋白排泄显著下降，而硝苯地平治疗后未出现这种情况。硝苯地平组心率较高。
尽管存在轻至中度慢性肾衰竭，硝苯地平GITS的利钠能力依然存在。这种作用在肾血流动力学无变化的情况下发生，提示其由直接的肾小管效应引起。
