Effect of ramipril on blood pressure and protein excretion rate in normotensive nondiabetic patients with proteinuria.
Effect of ramipril on blood pressure and protein excretion rate in normotensive nondiabetic patients with proteinuria.
复制标题
雷米普利对血压正常、有蛋白尿的非糖尿病患者血压和蛋白排泄率的影响。
DOI：
10.1016/s0272-6386(96)90382-0
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Smith,RD
中科院分区：
文献类型：
--
作者：
Toto,RD;Adams-Huet,B;Fenves,AZ;Mitchell,HC;Mulcahy,W;Smith,RD
血管紧张素转换酶抑制剂可减少血压正常和高血压合并蛋白尿肾病患者的蛋白尿。然而，其抗蛋白尿作用的机制尚不清楚。我们进行了一项前瞻性、双盲、安慰剂对照、随机交叉试验，以验证雷米普利的抗蛋白尿作用是由于改善了与血压和肾小球滤过率无关的肾小球通透性。对15例血压正常的非糖尿病蛋白尿患者进行了小剂量(1.25 mg/d)和大剂量(5 mg/d)雷米普利的疗效评价。这项研究分为四个12周的阶段：安慰剂、高剂量或低剂量雷米普利、交叉使用低剂量或高剂量雷米普利，以及安慰剂。在每个周期结束时测量血压、肾小球滤过率、肾血浆流量、尿蛋白排泄率和血浆血管紧张素II水平。低剂量和高剂量雷米普利治疗后，平均动脉压、尿蛋白/肌酐比值和白蛋白排泄率均显著降低。肾小球滤过率和肾血浆流量无明显变化。低剂量和高剂量雷米普利均可降低血浆血管紧张素II水平。没有低血压发作，只有一名受试者在雷米普利期间出现咳嗽，不需要停止研究药物。总之，在这组血压正常的患有各种蛋白尿性肾脏疾病的患者中，服用低剂量和高剂量雷米普利均可降低血压和减少蛋白尿。雷米普利的抗蛋白尿作用可能是通过降低肾小球毛细血管压力来实现的。
Angiotensin-converting enzyme inhibitors reduce proteinuria in both normotensive and hypertensive patients with proteinuric renal disease. However, the mechanism of the antiproteinuric effect has not been clarified. We performed a prospective, double-blind, placebo-controlled, randomized crossover trial to test the hypothesis that the antiproteinuric effect of ramipril was due to an improvement in glomerular permselectivity independent of blood pressure and glomerular filtration rate. The effect of low-dose (1.25 mg/d) and high-dose (5 mg/d) ramipril was assessed in 15 normotensive nondiabetic patients with proteinuria (> 150 mg/d). The study was divided into four 12-week periods: placebo, high- or low-dose ramipril, crossover to low- or high-dose ramipril, and placebo. Blood pressure, glomerular filtration rate, renal plasma flow rate, urinary protein excretion rate, and plasma angiotensin II levels were measured at the end of each period. Mean arterial pressure, urine protein to creatinine ratio, and albumin excretion rate decreased significantly during low- and high-dose ramipril. Glomerular filtration rate and renal plasma flow rate were not changed significantly. Plasma angiotensin II levels decreased with both low- and high-dose ramipril. There were no episodes of hypotension and only one subject developed cough during ramipril that did not require discontinuation of the study drug. In conclusion, administration of ramipril in both low and high doses lowered blood pressure and reduced proteinuria in this cohort of normotensive patients with a variety of proteinuric renal diseases. The antiproteinuric effect of ramipril is probably mediated by a reduction in glomerular capillary pressure.