Effects of monotherapy of temocapril or candesartan with dose increments or combination therapy with both drugs on the suppression of diabetic nephropathy
Effects of monotherapy of temocapril or candesartan with dose increments or combination therapy with both drugs on the suppression of diabetic nephropathy
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DOI：
10.1291/hypres.30.325
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发表时间：
2007-04-01
影响因子：
5.4
通讯作者：
Ito, Sadayoshi
中科院分区：
文献类型：
--
作者：
Ogawa, Susumu;Takeuchi, Kazuhisa;Ito, Sadayoshi
我们研究了增加血管紧张素转换酶抑制剂（ACEIs）或血管紧张素受体阻滞剂（ARBs）的推荐初始剂量，或切换到两种药物联合治疗对糖尿病肾病的影响。尿白蛋白排泄量（ACR）在100 ~ 300mg /g肌酐（Cre）之间的高血压2型糖尿病患者被分为以下5组，每组以推荐的初始剂量服用降压药48周，然后将剂量加倍或在接下来的48周内添加额外的药物：N，硝苯地平- cr (N) 20 mg/天（初始剂量）；T， ACEI替莫april (T) 2mg /d；C、ARB坎地沙坦(C) 4mg /天；T+C，先T再加C；T组（n=34）、C组（n=40）、T+C组（n=37）和C+T组（n=35） ACR降低，而n组（n=18） ACR无显著差异。然而，T组的抗蛋白尿作用低于C、T+C或C+T组，而后三者之间没有差异。各组患者血压与ACR呈显著线性关系；然而，与N组相比，肾素-血管紧张素系统抑制组的回归线向较低的ACR水平偏移。这些结果表明，ACEI和/或ARB在延缓糖尿病肾病方面优于CCB，而低剂量ACEI和ARB联合使用的效果与高剂量ARB相似。即使在接受ACEI和/或ARB治疗的患者中，降血压也很重要。
We examined the effects of increasing the recommended initial doses of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), or of switching to combination therapy with both drugs, on diabetic nephropathy. Hypertensive type 2 diabetic patients with urinary albumin excretion (ACR) between 100 and 300 mg/g creatinine (Cre) were assigned to the following five groups in which an antihypertensive drug was administered at a recommended initial dose for 48 weeks, and then either the dose was doubled or an additional drugs was added to regimen for the following 48 weeks: N, nifedipine-CR (N) 20 mg/day (initial dose); T, ACEI temocapril (T) 2 mg/day; C, ARB candesartan (C) 4 mg/day; T+C, T first and then addition of C; C+T, C first and then addition of C. ACR decreased in the T (n=34), C (n=40), T+C (n=37) and C+T (n=35) groups, but not in the N group (n=18). However, the anti-proteinuric effect was less in the T than in the C, T+C or C+T groups, while no differences existed among the latter three. In each group, there were significant linear relationships between attained BP and ACR; however, the regression lines were shifted toward lower ACR level in the renin-angiotensin system-inhibition groups compared with the N group. These results indicate that an ACEI and/or ARB is superior to a CCB in retarding diabetic nephropathy, while the combination of low doses of ACEI and ARB has effects similar to those of high-dose ARB. Even among patients treated with an ACEI and/or ARB, lowering BP is important.