左旋氨氯地平与福辛普利联用对血压晨冲异常升高患者肾功能影响的观察

目的 探讨左旋氨氯地平、福辛普利联合治疗对血压晨冲异常升高的高血压患者降压疗效和肾功能的影响. 方法 入选患者104例随机分为3组.左旋氨氯地平组34例(2.5 mg,1次/d);福辛普利组35例(10 mg,l次/d);左旋氨氯地平、福辛普利联用组35例.观察时间12个月.测定基线和治疗后血压、尿白蛋白排泄率(UAE)、血清肌酐(Scr)、尿肌酐(Ucr),计算肌酐清除率(Ccr). 结果 3组治疗后均能显著降低血压及UAE(均P<0.01).3组治疗后组间比较差异有统计学意义(P<0.01).联合用药组Ccr由治疗前的(79.1±6.8)ml/min上升为(109.6±16.1)ml/min(P<0.01). 结论 左旋氨氯地平、福辛普利单独治疗和联合治疗对血压晨冲异常升高患者均可明显降低血压,并可减少尿白蛋白排出,保护肾功能.两药联合治疗对降低血压、保护肾功能效果更好.

Effect of renal function in patients with blood pressure morning surge increasing obviously by levoamlodipine and fosinopril

Objective To observe the treatment effect of renal function and blood pressure in patient with blood pressure morning surge.Methods 34 patients take levoamlodipine 2.5 mg/q orally.35 patients take Fosinopril 10 mg/q orally.35 patients take Fosinopril lOmg/q and levoamlodipine 2.5 mg/q orally,continuing 12 months. Blood pressure,urinary albumin excretory rate,scrllm creatinine,urinary creatinine and calculated creatinine clearance at base line were measured.Results Blood pressure (P<0.01) and urinary albumin excretory rate (P<0.01) were decreased by compare to pretherapy in three groups.Post-treatment,urinary albumin excretory rate was reduced from 103.8±44.2 to (84.6±37.5)μg/min in the first group,from 102.9±45.4 to(82.7±38.4)μg/min in the second group,and from 109.8±40.5 to(51.2±40.1)μg/min in the last group.The difference for urinary albumin excretory rate was significant between prior treatment and post-treatment in every group (P<0.05).It is the same between the first group and the second.The difference for urinary albumin excretory rate was significant between the first group and the third group (P<0.01).The difference was significant between the second groud and the third group (P<0.01).Post-treatment,calculated creatinine clearance rate was increased from 84.6±7.4 to 88.2±7.1 in the first group,from 81.4±2.5 to 84.5±4.2 in the second group,and from 79.1±6.8 to 109.6±16.1 in the last group.The difference for calculated creatinine clearance rate was significant between prior treatment and post-treatment in the third group (P<0.01).Conclusion Blood pressure (P<0.01) and urinary albumin excretory rate were decreased by three methods.Three methods all protect renal function,and the third method is the best.