Combination of half doses of angiotensin type 1 receptor antagonist and angiotensin-converting enzyme inhibitor in diabetic nephropathy.
Combination of half doses of angiotensin type 1 receptor antagonist and angiotensin-converting enzyme inhibitor in diabetic nephropathy.
复制标题
DOI：
10.1016/j.amjhyper.2004.08.001
复制
发表时间：
2005
影响因子：
3.2
通讯作者：
T. Fujisawa;H. Ikegami;M. Ono;M. Nishino;S. Noso;Y. Kawabata;T. Ogihara
中科院分区：
文献类型：
--
作者：
T. Fujisawa;H. Ikegami;M. Ono;M. Nishino;S. Noso;Y. Kawabata;T. Ogihara
背景：为探讨血管紧张素I转换酶抑制剂和血管紧张素I受体拮抗剂(ARB)联合治疗对糖尿病肾病的肾脏保护作用，对2型糖尿病合并白蛋白尿患者给予两药各一半的治疗。方法对27例接受咪达普利10 mg或坎地沙坦8 mg/d治疗的2型糖尿病患者进行尿白蛋白指数(UAI)和血压(BP)的测定。然后用5毫克咪达普利和4毫克坎地沙坦的组合来替代任何一种药物。在联合治疗3个月后，测量UAI和BP。结果治疗前后血压差异无统计学意义，但经对数变换后的尿微量白蛋白指数显著降低(P=0.003)，由治疗前的79.4mgCre降至52.5mggCre。结论在2型糖尿病肾病患者中，血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂双重阻断肾素系统可显著减少蛋白尿，即使药物剂量减少一半，仍可起到肾脏保护作用。Am J Hyperten 2005；18：13-17©2005美国高血压杂志。
Background:To investigate the renoprotective effect of combination therapy with an angiotensin I converting enzyme inhibitor and an angiotensin type I receptor blocker (ARB) on diabetic kidney disease, half doses of each monotherapy were given to type 2 diabetic patients with albuminuria.MethodsUrinary albumin index (UAI) and blood pressure (BP) were measured in a total of 27 outpatients with type 2 diabetes mellitus receiving 10 mg imidapril or 8 mg candesartan per day. Either agent was then substituted with a combination of 5 mg imidapril and 4 mg candesartan. After 3 months of combination therapy, UAI and BP were measured. Changes in the parameters were assessed by pairedttest.ResultsAlthough BP was not significantly different prior to and at the end of combination therapy, log-transformed UAI was significantly reduced (P = 0.003) from an initial UAI (mean log-transformed UAI ± SD) of 79.4 (27.4–231)mg/g Cre to 52.5 (17.1–161)mg/g Cre at the end of combination therapy. The reduction was not associated with the initial UAI, initial BP, decrease in BP, pretreatment medication or other concomitant antihypertensive agents.ConclusionsIn patients with type 2 diabetes and nephropathy, dual blockade of the renin system with an angiotensin-converting enzyme inhibitor and angiotensin receptor blocker significantly reduces albuminuria and, thus, may be renoprotective even when the doses of the agents are reduced by one half. Am J Hypertens 2005; 18:13–17 © 2005 American Journal of Hypertension, Ltd.