不同治疗方案对原发性高血压患者微量白蛋白尿逆转的作用  

Effects of different antihypertensive strategies on reversing urinary albumin excretion

作　　者：王鸿懿[1] 孙宁玲[1] 陈源源[1] 马志毅[1] 喜杨[1] 王鲁雁[1] 杨帆[1] 

机构地区：[1]北京大学人民医院心脏中心,100044

出　　处：《中华医学杂志》2013年第35期2810-2812,共3页National Medical Journal of China

基　　金：国家十一五科技支撑项目（2006BA101A03）

摘　　要：目的观察不同药物治疗方案对合并微量白蛋白尿的高血压患者血压达标及蛋白尿改善情况。方法多中心随机阳性药平行对照干预研究。入选2010-2011年在22家医院门诊就诊的合并微量白蛋白尿的轻中度原发性高血压患者531例，随机分为钙拈抗剂（CCB）组、血管紧张素受体拮抗剂（ARB）组和CCB＋ARB组。共随访6个月。结果（1）治疗6个月后，CCB、ARB和CCB＋ARB三组蛋白尿分别降低20．6mg／L、27．6mg／L和30．9mg／L，单因素方差分析P=0．067。（2）血压达标者和未达标者蛋白尿降低幅度分别为31．1mg／L和6．6mg／L，P〈0．001。结论有效降压是减少高血压患者尿白蛋白排出的关键，其中含ARB的治疗方案减少尿白蛋白有高于钙拮抗剂组的趋势。Objective To explore the effects of different antihypertensive strategies on blood pressure and urinary albumin excretion in patients with hypertension and microalbuminuria. Methods For this multi-center, randomized, positively controlled clinical trial, a total of 53l patients with mild-to- moderate essential hypertension and microalbuminuria were enrolled. They were divided randomly into calcium channel blocker （CCB） , angiotensin Ⅱ receptor antagonist （ARB） and CCB ＋ ARB groups. The whole treatment period was 6 months. Results According to ANOVA analysis, the post-therapeutic urinary albumin level decreased 20.6, 27.6 and 30.9 mg/L in CCB, ARB and CCB ＋ ARB groups respectively （ P = 0. 067 ）. And the extents of urinary albumin reduction were 31. 1 and 6.6 mg/L in patients with controlled and uncontrolled blood pressure respectively （P 〈 0. 001 ）. Conclusion Effective antihypertensive therapy is a key for decreasing urinary albumin excretion in hypertensive patients. As compared with calcium antagonists, ARB-eontaining regimens appear to be better in reducing urinary albumin.

关 键 词：高血压 白蛋白尿 钙离子拮抗剂 血管紧张素Ⅱ受体拮抗剂 

分 类 号：R544.1[医药卫生—心血管疾病]