卡维地洛治疗肾病患者难治性高血压的前瞻性多中心临床研究

目的 评价卡维地洛治疗各种肾脏病患者中难治性高血压的安全性、降压疗效和其对心肾功能的影响。方法 采用前瞻性、多中心、开放、自身对照试验，入选患者共217例，观察期限为8周。结果与用药前相比，所有患者治疗4周后平均收缩压（SBP）和舒张压（DBP）均明显下降（P〈0．01）。卡维地洛治疗4周降压有效率达57．1％，显效率为11．5％；至用药8周时有效率达79．7％，显效率为26．7％。治疗后平均心率有所下降，由治疗前（79．3±10．2）次／min下降为4周时（75．9±7．6）次／min和8周时的（75．0±8．5）次／min（P〈0．05），但仍处于正常范围。血浆中去甲肾上腺素平均水平由治疗前38．7ng／L降至17．6ng／L（P〈0．05）。卡维地洛治疗后患者肝肾功能、心电图均无明显改变，不良反应轻微。结论 卡维地洛治疗肾病患者难治性高血压安全有效。

Treatment of carvedilol for refractory hypertension in patients with kidney disease: a multi-center，prospective clinical trial

Objective To evaluate the efficiency and safety of carvedilol (Dilatrend®) in refractory hypertensive patients with different kidney diseases. Methods A multi-centre, prospective，opening, self-compared trial was conducted. Two hundred and seventeen patients were enrolled in this study. Before and after 8-week treatment, blood pressure, heart rate, plasma norepinephrine and serum creatinine etc. were measured and recorded. Results Mean blood pressure at 4th week significantly reduced in comparison with that before the use of carvedilol (P < 0.05). Total and dominant efficiency were 57.1% and 11.5% at 4th week, 79.7% and 26.7% at 8th week. Mean heart rate declined from 79.3±10.2 per minute to 75.9±7.6 per minute at 4th week, and 75.0±8.5 per minute at 8th week (P< 0.05). Mean plasma norepinephrine level decreased from 38.7 ng/L before trial to 17.6 ng/L (P < 0.05). Adverse events usually appeared mild, and no obvious changes of biochemical parameters of liver and renal function and electrocardiogram were found. Conclusion Carvedilol is an efficient and safe antihypertensive drug in treatment of different kidney diseases.