地尔硫缓释片与卡托普利对原发性高血压早期肾功能的保护作用

目的 :研究地尔硫缓释片与卡托普利对原发性高血压所致的肾小球滤过功能与肾小管重吸收功能损害的保护作用。方法 :5 4例原发性高血压病人随机分为地尔硫治疗组 30例 ,给地尔硫缓释片 90mg ,po ,bid ;卡托普利组 2 4例 ,给卡托普利2 5mg ,po ,tid ;疗程为 4wk。研究前后分别测定血清肌酐 (Cr)、每分钟内生肌酐清除率 (CCr)、尿素氮(BUN )、β2 微球蛋白 (β2 MG )、2 4h尿清蛋白(ALB) ,尿 β2 MG的排泄率。结果 :入选病人治疗前血Cr ,BUN无明显增高 ,而血 β2 MG ,2 4h尿清蛋白 ,尿 β2 MG的排泄量均有所增加 ;经 4wk治疗 ,地尔硫缓释片与卡托普利均能使血压降至正常 ,地尔硫组血、尿 β2 MG ,2 4h尿清蛋白 (ALB)分别降至 (2 .2± 0 .4 )mg·d- 1,(0 .32± 0 .2 7)mg·L- 1和 (12± 5 )mg·L- 1(P <0 .0 5 ) ,Cr与BUN水平同治疗前相当 ;卡托普利组研究期间有 4例病人不能耐受咳嗽退出研究 ,地尔硫组未有不良反应发生 ,无 1例终止研究。结论 :原发性高血压肾损害微蛋白尿出现先于血Cr与BUN的升高 ,地尔硫缓释片与卡托普利一样可有效控制血压 ,同时降低血和尿 β2 MG及尿清蛋白量 ,改善肾脏功能 ,地尔硫组病人依从性好于卡托普利组

Efficacy of diltizem SR and captopril on renal function in essential hypertension patients

AIM: To study the protective effect of diltizem SR and captopril on renal injury in essential hypertension patients. METHODS: After the treatment with diltizem SR (180 mg·d -1 ) and captopril (75 mg·d -1 ) for 4 wk, the serum creatinine (Cr), blood urea nitrogen (BUN), endogenous creatinine clearance rate (CCr), the serum β 2 microglobulin, 24 h urine protein (albumin β 2 microglobulin) excretion, urine sodium were measured before and after treatment. RESULTS: In the essential hypertention patients, the normal Cr, CCr. and BUN not increased sigmfiemtly, but the serum β 2 MG and the 24 h total urine albumin, β 2 MG excretion slighty increased compared with the control. Both diltizem SR and captopril could decrease the blood pressure to normal, the serum β 2 MG, 24 h total urine albumin and β 2 MG excretion decreased to (2.2±0.4)mg·L -1 ,( 0.32 ±0.27)mg·L -1 and (12±5)mg·L -1 respectively after 4 wk treatment. CONCLUSION: A small amount of urine protein, which was detected before the increase of serum Cr, indicated the occurrence of early stage pathological damage of renal due to essential hypertention. Diltizem SR as well as captopril can improve renal function, countrol the blood pressure effectively and decrease the serum β 2 MG and urine allumin, but the compliance in diltizem group is better than that in captopril group.