Dual blockade of the renin-angiotensin system in type 1 patients with diabetic nephropathy
Dual blockade of the renin-angiotensin system in type 1 patients with diabetic nephropathy
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DOI：
10.1093/ndt/17.6.1019
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发表时间：
2002-06-01
影响因子：
6.1
通讯作者：
Parving, HH
中科院分区：
文献类型：
--
作者：
Jacobsen, P;Andersen, S;Parving, HH
背景白蛋白尿和高血压是糖尿病患者肾脏和心血管预后不良的预测因子。约30%的1型糖尿病肾病（DN）患者尽管使用推荐剂量的ACE抑制剂（ACEI）和利尿剂进行抗高血压治疗，但蛋白尿>1 g/天，血压>135和/或> 85 mmHg。我们测试了双重阻断这些患者的肾素-血管紧张素系统（RAS）的效果。我们进行了一项随机双盲交叉试验，厄贝沙坦300 mg o.d.治疗2个月。在既往抗高血压治疗基础上加用安慰剂。我们纳入了21例对ACEI和利尿剂反应不充分的1型DN患者，如上所述。在每个治疗期结束时，测量蛋白尿、24 h血压和肾小球滤过率（GFR）。在患者常规降压治疗基础上加用300 mg厄贝沙坦可使白蛋白尿平均减少37%（95%CI 20-49，P
Background. Albuminuria and hypertension are predictors of poor renal and cardiovascular outcome in patients with diabetes. Approximately 30% of type 1 patients with diabetic nephropathy (DN) have albuminuria >1 g/day, and blood pressure >135 and/or > 85 mmHg despite antihypertensive therapy with recommended doses of ACE inhibitor (ACEI) and diuretics. We tested the effect of dual blockade of the renin-angiotensin system (RAS) in these patients.Methods. We performed a randomised double blind crossover trial with 2 months treatment with Irbesartan 300 mg o.d. and placebo added on top of previous antihypertensive treatment. We included 21 type 1 patients with DN responding insufficiently to ACEI and diuretics, as defined above. At the end of each treatment period, albuminuria, 24-h blood pressure and glomerular filtration rate (GFR) were measured.Results. Addition of 300 mg Irbesartan to the patients' usual antihypertensive therapy induced a mean reduction in albuminuria of 37% (95% Cl 20-49, P