Pechère-Bertschi A, Nussberger J, Decosterd L, Armagnac C, Sissmann J, Bouroudian M, Brunner H R, Burnier M
Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
J Hypertens. 1998 Mar;16(3):385-93. doi: 10.1097/00004872-199816030-00016.
To compare the acute and sustained renal hemodynamic effects on hypertensive patients of 100 mg irbesartan and 20 mg enalapril each once daily.
Twenty patients (aged 35-70 years) with uncomplicated, mild-to-moderate essential hypertension and normal serum creatinine levels completed this study.
After random allocation to treatment (n=10 per group), administration schedule (morning or evening) was determined by further random allocation, with crossover of schedules after 6 weeks' therapy. Treatment and administration assignments were double-blind. Twenty-four-hour ambulatory blood pressure was monitored before and after 6 and 12 weeks of therapy. Renal hemodynamics were determined on the first day of drug administration and 12 and 24 h after the last dose during chronic treatment.
Administration of each antihypertensive agent induced a renal vasodilatation with no significant change in glomerular filtration rate. However, the time course appeared to differ: irbesartan had no significant acute effect 4 h after the first dose, but during chronic administration a renal vasodilatory response was found 12 and 24 h after the dose; enalapril was effective acutely and 12 h after administration, but no residual effect was found 24 h after the dose. Both antihypertensive agents lowered mean ambulatory blood pressure effectively, with no significant difference between treatments or between administration schedules (morning versus evening).
Irbesartan and enalapril have comparable effects on blood pressure and renal hemodynamics in hypertensive patients with normal renal functioning. However, the time profiles of the renal effects appear to differ, which might be important for long-term renoprotective effects.
比较每日一次服用100毫克厄贝沙坦和20毫克依那普利对高血压患者的急性和持续性肾脏血流动力学影响。
20名年龄在35 - 70岁之间、患有单纯性轻至中度原发性高血压且血清肌酐水平正常的患者完成了本研究。
随机分配至治疗组（每组10人）后，通过进一步随机分配确定给药时间（早晨或晚上），6周治疗后交叉给药时间。治疗和给药分配均为双盲。在治疗6周和12周前后监测24小时动态血压。在给药第一天以及慢性治疗期间最后一剂药物后的12小时和24小时测定肾脏血流动力学。
每种抗高血压药物的给药均引起肾血管舒张，肾小球滤过率无显著变化。然而，时间进程似乎有所不同：厄贝沙坦在首剂给药4小时后无显著急性效应，但在慢性给药期间，在给药后12小时和24小时发现肾血管舒张反应；依那普利在给药后急性有效且12小时后仍有效，但在给药后24小时未发现残留效应。两种抗高血压药物均有效降低平均动态血压，治疗组之间或给药时间（早晨与晚上）之间无显著差异。
厄贝沙坦和依那普利对肾功能正常的高血压患者的血压和肾脏血流动力学具有相似的作用。然而，肾脏效应的时间模式似乎有所不同这可能对长期肾脏保护作用很重要。
