Rachmani R, Levi Z, Slavachevsky I, Half-Onn E, Ravid M
Department of Medicine, Sackler Faculty of Medicine, Tel-Aviv University and Meir Hospital, Kfar-Sava, Israel.
Nephron. 1998 Oct;80(2):175-82. doi: 10.1159/000045163.
alpha-Adrenergic blockers are potential alternative antihypertensive agents for diabetic patients. Data on their relative efficacy and their effect on kidney function and albuminuria are very limited however. 76 patients with diabetes type 2, hypertension (>/=140/90 mm Hg) and albuminuria (>/=30 mg/24 h) were randomized into three groups to receive cilazapril (2.5-10 mg), doxazosin (2-8 mg) or both. Patients of the first and second groups received a single agent for 4 months, the agents were then crossed for an additional period of 4 months followed by the addition of hydrochlorothiazide (25 mg) for a third 4-month period. Blood pressure was monitored monthly, creatinine clearance and HbA1c were measured before and at the end of each treatment period. Patients of the third group received reduced doses of cilazapril and doxazosin for 4 months. Hydrochlorothiazide was then added for the subsequent 4 months. There was a significant decline in blood pressure values during the first period in all groups. Cilazapril: systolic blood pressure (SBP) 160 +/- 6 to 149 +/- 5 mm Hg; diastolic blood pressure (DBP): 101 +/- 3 to 94 +/- 3 mm Hg (p = 0.001). Albuminuria declined from 350 +/- 105 to 205 +/- 96 mg/24 h (p = 0.001), creatinine clearance (CrCl) was unchanged. Doxazosin: SBP: 160 +/- 7 to 151 +/- 6 mm Hg; DBP: 97 +/- 4 to 90 +/- 4 mm Hg (p = 0.001). Albuminuria 373 +/- 121 to 322 +/- 107 mg/24 h (p = 0.065) and CrCl 87 +/- 7 to 91 +/- 6 ml/min. The combination of both agents at half doses was equipotent or superior to either drug alone. Cross-over of cilazapril and doxazosin reproduced the hypotensive effect and reversed the antialbuminuric effect. The addition of hydrochlorothiazide resulted in a further decline of 6-14 mm Hg in SBP and 3-11 mm Hg in DPB.
α-肾上腺素能阻滞剂是糖尿病患者潜在的替代降压药物。然而，关于它们的相对疗效以及对肾功能和蛋白尿影响的数据非常有限。76例2型糖尿病、高血压（收缩压/舒张压≥140/90 mmHg）和蛋白尿（≥30 mg/24 h）患者被随机分为三组，分别接受西拉普利（2.5 - 10 mg）、多沙唑嗪（2 - 8 mg）或两者联合治疗。第一组和第二组患者接受单一药物治疗4个月，之后药物交叉再治疗4个月，然后在第三个4个月期间加用氢氯噻嗪（25 mg）。每月监测血压，在每个治疗期开始和结束时测量肌酐清除率和糖化血红蛋白（HbA1c）。第三组患者接受低剂量的西拉普利和多沙唑嗪治疗4个月，随后4个月加用氢氯噻嗪。所有组在第一个治疗期血压值均显著下降。西拉普利组：收缩压（SBP）从160±6 mmHg降至149±5 mmHg；舒张压（DBP）：从101±3 mmHg降至94±3 mmHg（p = 0.001）。蛋白尿从350±105 mg/24 h降至205±96 mg/24 h（p = 0.001），肌酐清除率（CrCl）无变化。多沙唑嗪组：SBP：从160±7 mmHg降至151±6 mmHg；DBP：从97±4 mmHg降至90±4 mmHg（p = 0.001）。蛋白尿从373±121 mg/24 h降至322±107 mg/24 h（p = 0.065），CrCl从87±7 ml/min升至91±6 ml/min。两种药物半量联合的降压效果与单一药物相当或更优。西拉普利和多沙唑嗪交叉用药再现了降压效果，并逆转了抗蛋白尿作用。加用氢氯噻嗪后，收缩压进一步下降6 - 14 mmHg，舒张压下降3 - 11 mmHg。
