钙通道三相阻滞剂降压降尿蛋白疗效更好

Renal-protective effect of T-and L-type calcium channel blockers in hypertensive patients: an Amlodipine-to-Benidipine Changeover (ABC) study.

Both strict blood pressure control and efferent artery dilatation are critical in reducing proteinuria, which in turn helps to regulate blood pressure. Benidipine, an L- and T-type calcium channel blocker, has the potential for increased effectiveness compared with L-type-dominant calcium channel blockers such as amlodipine.

Therefore, we evaluated blood pressure and proteinuria after changeover from amlodipine to benidipine in poorly controlled hypertensive patients. Fifty-eight hypertensive outpatients undergoing amlodipine treatment and unable to achieve optimal blood pressure as determined by Japanese Society of Hypertension Guidelines for the Management of Hypertention (JSH 2004) were changed over to benidipine treatment.

We measured blood pressure and pulse rate and assessed urinary protein excretion before and after changeover. Systolic and diastolic blood pressure dropped from 151/90 mmHg to 140/81 mmHg (p<0.0001). Mean blood pressure (p<0.0001) and pulse pressure (p=0.0069) were also reduced, but pulse rate increased from 75 bpm to 78 bpm (p=0.0047). Urinary protein excretion adjusted for urinary creatinine was reduced from 0.35 +/- 0.82 to 0.22 +/- 0.55 g/g creatinine (p=0.0119). The urinary protein reduction was observed only in patients with renin-angiotensin inhibition (p=0.0216). By switching from amlodipine to benidipine treatment, more than 80% of patients reduced their blood pressure, and more than 40% achieved optimal blood pressure. Higher urinary protein excretion (p<0.0001), lower glomerular filtration rate (p=0.0011) and presence of diabetes (p=0.0284) were correlated with reduction of urinary proteins during changeover.

Taken together, our results suggest that benidipine may have greater efficacy than amlodipine in reducing blood pressure and proteinuria

翻译如下：

T或L型的钙离子通道的阻滞剂在高血压患者中对肾脏的保护作用：从使用氨氯地平换用贝尼地平的研究－（ABC）研究
严格的血压控制和输出动脉滤过率的下降都是降低蛋白尿的关键因素，而反过来蛋白尿的降低有助于血压的控制。贝尼地平，是L和T型的钙离子拮抗剂，和L型占优势的钙离子拮抗剂（如氨氯地平）相比，在降低蛋白尿方面更加有效。
在血压控制不佳的患者中，我们用贝尼地平替代氨氯地平，而后评估换药后的血压和蛋白尿。58名使用氨氯地平治疗的，血压没有达到既定目标值的门诊病人，根据日本科学院的高血压指南，我们将氨氯地平换成贝尼地平。
在将氨氯地平换成贝尼地平的前后，我们分别测定高血压患者的血压、脉率及尿蛋白清除。将氨氯地平换成贝尼地平后，患者的收缩压和舒张压从151/90 mmHg降低至140/81 mmHg (p<0.0001).平均动脉压(p<0.0001)和脉压(p=0.0069)也同样降低。然而将氨氯地平换成贝尼地平后，脉搏却从75次/分上升至78次/分(p=0.0047)。将氨氯地平换成贝尼地平后，已被尿肌酐效准过的尿蛋白清除从0.35 +/- 0.82降低至0.22 +/- 0.55 g/g肌酐(p=0.0119)。只在使用血管紧张素的患者中发现尿蛋白的降低(p=0.0216)。从氨氯地平换用贝尼地平后，80％高血压患者的血压降低，超过40％的高血压患者血压达标。换药后的尿蛋白的下降与尿蛋白清除更多(p<0.0001)，肾小球滤过率降低(p=0.0011)，减少糖尿病的发生率(p=0.0284)相关。
综合上诉的研究结果，提示贝尼地平在降压和降低尿蛋白方面比氨氯地平更有效。