Buter H, Hemmelder M H, Navis G, de Jong P E, de Zeeuw D
Groningen Institute for Drug Studies, Division of Nephrology, State University Hospital, The Netherlands.
Nephrol Dial Transplant. 1998 Jul;13(7):1682-5. doi: 10.1093/ndt/13.7.1682.
Dietary sodium restriction enhances the antiproteinuric and blood pressure lowering effect of ACE inhibition. In clinical practice, however, long-term compliance to a low-sodium diet may be difficult to obtain. We therefore investigated whether the blunting of the antiproteinuric and blood pressure lowering efficacy of ACE inhibition by high sodium intake can be restored by the addition of a diuretic.
Seven proteinuric patients with non-diabetic renal disease on chronic ACE inhibition were studied during three consecutive 4-week periods: low sodium (50 mmol/day), high sodium (200 mmol/day) and high sodium plus hydrochlorothiazide (50 mg o.i.d.).
During low sodium intake proteinuria was 3.1 (0.7-5.2) g/day, during high sodium intake proteinuria increased to 4.5 (1.6-9.2) g/day (P < 0.05). Interestingly, addition of hydrochlorothiazide again reduced proteinuria to 2.8 (0.6-5.8) g/day (P < 0.05). Mean arterial blood pressure was 89 (84-96), 98 (91-104) and 89 (83-94) mmHg (P < 0.05) during the three periods, respectively.
Addition of hydrochlorothiazide can overcome the blunting of the therapeutic efficacy of ACE inhibition on proteinuria and blood pressure by a high sodium intake.
饮食限钠可增强血管紧张素转换酶（ACE）抑制剂的降蛋白尿及降压作用。然而在临床实践中，长期坚持低钠饮食可能难以做到。因此，我们研究了加用利尿剂是否能够恢复高钠摄入所致的ACE抑制剂降蛋白尿及降压疗效减弱的情况。
对7例接受慢性ACE抑制治疗的非糖尿病肾病蛋白尿患者进行了连续3个为期4周阶段的研究：低钠（50 mmol/天）、高钠（200 mmol/天）以及高钠加用氢氯噻嗪（50 mg，每日3次）。
低钠摄入期间蛋白尿为3.1（0.7 - 5.2）g/天，高钠摄入期间蛋白尿增至4.5（1.6 - 9.2）g/天（P < 0.05）。有趣的是，加用氢氯噻嗪后蛋白尿再次降至2.8（0.6 - 5.8）g/天（P < 0.05）。3个阶段的平均动脉血压分别为89（84 - 96）、98（91 - 104）和89（83 - 94）mmHg（P < 0.05）。
加用氢氯噻嗪可克服高钠摄入所致的ACE抑制剂对蛋白尿及血压治疗疗效的减弱。
