Dissociation between blood pressure reduction and fall in proteinuria in primary renal disease: a randomized double-blind trial
Dissociation between blood pressure reduction and fall in proteinuria in primary renal disease: a randomized double-blind trial
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原发性肾病患者血压降低与蛋白尿下降之间的关联：一项随机双盲试验
DOI：
10.1097/00004872-200204000-00032
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发表时间：
2002
影响因子：
4.9
通讯作者：
D. Sánz
中科院分区：
文献类型：
--
作者：
L. Ruilope;R. Fernández;J. Rodríguez;S. G. Vinuesa;J. Garrido;R. Romero;D. Jarillo;L. Raij;I. AlvarezCantalapiedra;M. Mercado;F. Campderá;D. Ibañez;F. Martín;J. Mora;J. Nieto;C. Vozmediano;L. Hortal;C. Plaza;P. Aljama;J. Gómez;S. Soriano;A. Pérez;L. Garcés;J. Segura;J. Bonet;A. Vigil;P. Gallar;A. Oliet;C. Bernis;D. Sánz
目的指南建议降低蛋白尿患者的阈值和目标血压。血压降低可能伴随着不同的蛋白尿下降，这取决于抗高血压药物。目的是比较不同药物在血压降至相同水平时蛋白尿的减少情况。设计前瞻性、随机、双盲、对照试验。设置12个西班牙语中心。患者共119例原发性肾病患者，血压> 130/85 mmHg，蛋白尿> 1 g/天，肌酐清除率> 50 ml/min。干预在4周的安慰剂导入期后，患者随机接受：阿替洛尔50 mg/天;群多普利2 mg/天;维拉帕米240 mg/天或维拉帕米180 +群多普利2 mg/天组合;在第4周进行强制双倍剂量滴定。治疗持续时间为6个月。结果测量血压、24小时蛋白尿、血清白蛋白和钙的变化。结果阿替洛尔组、群多普利组、维拉帕米组和维拉帕米+群多普利组的收缩压/舒张压（mmHg）分别为12.2/9.9、12.9/9.3、8.2/7.9和13.6/11.3，差异无统计学意义。群多普利组蛋白尿显著下降40.2% [95%可信区间（CI）24.3-56.2%]，维拉帕米+群多普利组蛋白尿显著下降48.5%[95%可信区间（CI）24.3-56.2%]，（95% CI，31.7-64.3%）伴血清白蛋白升高（群多普利：从3.86 ± 0.64到4.03 ± 0.67 g/dl;维拉帕米+群多普利：从4.15 ± 0.58到4.40 ± 0.51 g/dl）。结论对于蛋白尿型原发性肾病患者，适当剂量的降压药物可使血压显著下降。只有血管紧张素转换酶抑制剂（群多普利）治疗，单独或更好地与维拉帕米联合，减少蛋白尿和增加血清白蛋白。
Objective Guidelines recommend lower threshold and goal blood pressure (BP) for patients with proteinuria. BP reduction could be accompanied by a different fall in proteinuria depending of the antihypertensive drug. The objective was to compare proteinuria reduction when BP is lowered to the same level with different drugs. Design Prospective, randomized, double-blind, controlled trial. Setting 12 Spanish centres. Patients A total of 119 patients with primary renal disease, blood pressure > 130/85 mmHg, proteinuria > 1 g/day, and creatinine clearance ⩾ 50 ml/min. Intervention After a 4-week run-in placebo period, patients were randomized to: atenolol 50 mg/day; trandolapril 2 mg/day; verapamil 240 mg/day or verapamil 180 + trandolapril 2 mg/day combination; forced double-dose titration was carried out at the 4th week. Treatment duration was 6 months. Outcome measures Changes in BP, 24 h proteinuria, serum albumin and calcium. Results BP was significantly reduced with the four treatments [SBP/DBP (mmHg]: atenolol 12.2/9.9; trandolapril 12.9/9.3; verapamil 8.2/7.9 and verapamil + trandolapril 13.6/11.3) without differences between them. A significant fall in proteinuria was seen in the trandolapril, 40.2% [95% confidence interval (CI) 24.3–56.2%], and verapamil + trandolapril groups, 48.5% (95% CI, 31.7–64.3%) accompanied with increases in serum albumin (trandolapril: from 3.86 ± 0.64 to 4.03 ± 0.67 g/dl; verapamil + trandolapril: from 4.15 ± 0.58 to 4.40 ± 0.51 g/dl). Conclusions In patients with proteinuric primary renal disease, adequate dose titration of antihypertensive drugs may provide a substantial BP reduction. Only angiotensin-converting enzyme inhibitor (trandolapril) treatment, alone or better combined with verapamil, reduces proteinuria and increases serum albumin.