Anti-albuminuric effect of the aldosterone blocker eplerenone in non-diabetic hypertensive patients with albuminuria: a double-blind, randomised, placebo-controlled trial
Anti-albuminuric effect of the aldosterone blocker eplerenone in non-diabetic hypertensive patients with albuminuria: a double-blind, randomised, placebo-controlled trial
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DOI：
10.1016/s2213-8587(14)70194-9
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发表时间：
2014-12-01
影响因子：
44.5
通讯作者：
Fujita, Toshiro
中科院分区：
文献类型：
--
作者：
Ando, Katsuyuki;Ohtsu, Hiroshi;Fujita, Toshiro
背景肾素-血管紧张素系统抑制剂对慢性肾脏病患者具有肾脏保护作用，但大多数接受这些药物治疗的患者存在残余尿白蛋白排泄。一些小型临床研究表明，盐皮质激素受体阻断可减少蛋白尿。我们的研究旨在探讨在患有非糖尿病慢性肾病的高血压患者中添加选择性醛固酮拮抗剂依普利酮对肾素-血管紧张素系统抑制剂的有益效果。 方法 在这项双盲、随机、安慰剂对照试验中，我们纳入了年龄为 20-79 岁、患有白蛋白尿（2019 年清晨首次空尿中的尿白蛋白与肌酐比值 [UACR]）的高血压患者。 30-599 mg/g)，估计肾小球滤过率为 50 mL/min/1.73 m(2) 或以上，并且已接受血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂或两者治疗至少 8 周。参与者来自日本 59 家诊所和医院。符合条件的患者被随机分配（1:1），按基线特征分层，接受低剂量依普利酮（50 mg/天）或安慰剂，两组均未记录继续标准抗高血压治疗以达到治疗目标（5.5 mmol/L）。 解释 在肾素-血管紧张素系统抑制剂中添加低剂量依普利酮可能通过减少高血压患者的蛋白尿而产生肾脏保护作用患有非糖尿病慢性肾病，没有严重的安全问题。
Background Renin-angiotensin system inhibitors have renoprotective effects in patients with chronic kidney disease, but most patients treated with these drugs have residual urinary albumin excretion. Some small clinical studies show that mineralocorticoid receptor blockade reduces albuminuria. Our study aimed to examine the beneficial effects of addition of a selective aldosterone antagonist, eplerenone, to renin-angiotensin system inhibitors in hypertensive patients with non-diabetic chronic kidney disease.Methods In this double-blind, randomised, placebo-controlled trial, we enrolled hypertensive patients, aged 20-79 years, with albuminuria (urinary albumin-to-creatinine ratio [UACR] in the first morning void urine of 30-599 mg/g), an estimated glomerular filtration rate of 50 mL/min per 1.73 m(2) or more, and who had received an angiotensin-converting enzyme inhibitor, an angiotensin receptor blocker, or both, for at least 8 weeks. Participants were from 59 clinics and hospitals in Japan. Eligible patients were randomly assigned (1: 1), stratified by baseline characteristics, to either low-dose eplerenone (50 mg/day) or placebo, with continuation of standard antihypertensive treatment to attain therapeutic goals (5.5 mmol/L) was not recorded in either group.Interpretation Addition of low-dose eplerenone to renin-angiotensin system inhibitors might have renoprotective effects through reduction of albuminuria in hypertensive patients with non-diabetic chronic kidney disease, without serious safety concerns.