OBJECTIVE:Most calcium antagonists do not seem to reduce microalbuminuria or proteinuria. We have tried to assess the antiproteinuric effect of a calcium channel blocker, lercanidipine, in patients previously treated with ACE inhibitors or angiotensin receptor blockers. DESIGN AND METHODS:The study included 68 proteinuric (> 500 mg/day) patients (age 63.1 +/- 12.9 years, 69.1% males and 30.9 females). All patients were receiving ACE inhibitors (51.4%) or angiotensin II receptor blockers (48.6%) therapy but had higher blood pressure than recommended for proteinuric patients (<130/80 mmHg). Patients were clinically evaluated one, three, and six months after starting treatment with lercanidipine (20 mg/day). Samples for urine and blood examination were taken during the examination. When needed, a third drug was added to treatment. Creatinine clearance was measured using 24 h urine collection. RESULTS:BP significantly decreases from 152 +/- 15/86 +/- 11 mmHg to 135 +/- 12/77 +/- 10 mmHg at six months of follow-up (p < 0.001). After six months of treatment, the percentage of normalized patients (BP < 130/80 mmHg) was 42.5%, and the proportion of patients whose BP was below 140/90 mmHg was 58.8%. Plasmatic creatinine did not change nor did creatinine clearance. Plasmatic cholesterol also decreased from 210 +/- 48 to 192 +/- 34 mg/dL (p < 0.001), as did plasma triglycerides (from 151 +/- 77 to 134 +/- 72 mg/dL, p = 0.022). Basal proteinuria was 1.63 +/- 1.34 g/day; it was significantly (p < 0.001) reduced by 23% at the first month, 37% at three months, and 33% at the last visit. CONCLUSIONS:Lercanidipine at 20 mg dose, associated to renin-angiotensin axis-blocking drugs, showed a high antihypertensive and antiproteinuric effect. This antiproteinuric effect seems to be dose-dependent as compared with previous reports and proportionally higher than blood pressure reduction.

译文

目的:大多数钙拮抗剂似乎并未减少微量白蛋白尿或蛋白尿。我们已尝试评估钙通道阻滞剂lercanidipine在先前使用ACE抑制剂或血管紧张素受体阻滞剂治疗的患者中的抗蛋白尿作用。
设计与方法:该研究包括68位蛋白尿(> 500 mg /天)患者(年龄63.1 /-12.9岁,男性69.1%,女性30.9)。所有患者均接受ACE抑制剂(51.4%)或血管紧张素II受体阻滞剂(48.6%)治疗,但血压高于蛋白尿患者推荐的血压(<130/80 mmHg)。在开始使用lercanidipine(20 mg / day)治疗后的一个月,三个月和六个月,对患者进行了临床评估。在检查过程中采集了尿液和血液检查样本。需要时,将第三种药物添加到治疗中。使用24小时尿液收集测定肌酐清除率。
结果:在六个月的随访中,BP显着降低,从152 /-15/86 /-11 mmHg降至135 /-12/77 /-10 mmHg(p <0.001)。治疗六个月后,正常患者(BP <130/80 mmHg)的百分比为42.5%,血压低于140/90 mmHg的患者比例为58.8%。血浆肌酐没有改变,肌酐清除率也没有改变。血浆胆固醇也从210 /-48降至192 /-34 mg / dL(p <0.001),血浆甘油三酸酯也从151 /-77降至134 /-72 mg / dL,p = 0.022。基础蛋白尿为1.63 / 1.34 g /天;第一个月显着降低(p <0.001),三个月降低37%,最后一次访视降低33%(p <0.001)。
结论:20mg剂量的Lercanidipine与肾素-血管紧张素轴阻滞药物有关,具有较高的抗高血压和抗蛋白尿作用。与以前的报道相比,这种抗蛋白尿作用似乎是剂量依赖性的,并且比降血压成比例地更高。

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