氨氯地平和坎地沙坦联用对原发性高血压尿微量清蛋白的影响

目的 评价联合应用钙拮抗剂(氨氯地平)和血管紧张素Ⅱ受体拮抗剂(坎地沙坦)及单用对原发性高血压患者血压及尿微量清蛋白(MAU)的影响.方法 高血压1、2级伴MAU阳性门诊患者90例,随机分为联合用药组(氨氯地平5mg/d+坎地沙坦8mg/d,n=30)、单用氨氯地平组(5mg/d,n=30)和单用坎地沙坦组(8mg/d,n=30).治疗2周后单用组血压未达标者剂量加倍以达目标血压,疗程共6个月.记录治疗前、治疗后3个月和6个月血压、MAU的变化及可能发生的不良事件.结果 治疗3个月后3组血压均较治疗前明显下降(P＜0.01),且联合组较坎地沙坦组降压更明显(P＜0.01),与氨氯地平组无明显差异,治疗6个月后联合组较氨氯地平组显示降压更有效(P＜0.05);3组治疗3个月后MAU均较治疗前明显减少(P＜0.01),且随时间延长作用更明显.两个单用组与联合用药组比较,坎地沙坦组优于氨氯地平组(P＜0.01),联合组优于坎地沙坦组(P＜0.05).结论 钙拮抗剂类药物和血管紧张素Ⅱ受体拮抗剂联用较单一药物剂量加倍对血压控制情况有明显优势,且能更好改善高血压患者的早期肾损害,提示早期肾损害者应尽早联合降压治疗.

Effect of Two Kinds of Drugs Combination Therapy Amlodipine,Candesartan on Microalbuminuria in Patients with Hypertension

Objective To evaluate the effect of microalbuminuria of combined treatment with calcium antagonist(amlodipine)(CCB)and the ARB(candesartan),or amlodipine,candesartan monotherapy in patients with hypertension.Methods Ninety cases of consecutive patients with hypertension were randomized to receive amlodipine 5mg/d(n=30),candesartan 8mg/d(n=30),or a combination of amlodipine 5mg/d and candesartan 8mg/d(n=30)for 6 months.After 2 weeks in monotherapy group dose was doubled to the sixth month end.The blood pressure as well as microalbuminuria were examed before and after 3 months、6 months treatment and recorded the adverse events.Results The treatment of three groups all significantly lowered BP(P<0.01),and the combination treatment group lowered more.Urine MAU were decreased in all guoups(P<0.01),the combination treatment group decreased more significantly than either monotherapy approaches(P<0.05,P<0.01).Conclusion The combination of amlodipine and candesartan resulted in significantly more decrease in microalbuminuria than monotherapy with either agent in patients with hypertension.