缬沙坦及贝那普利联合用药对高血压患者尿微量白蛋白的影响

目的观察血管紧张素II受体拮抗剂（ARB）类药物缬沙坦及血管紧张素转换酶抑制剂（ACEI）类药物贝那普利联合用药与大剂量单药（缬沙坦或贝那普利）对原发性高血压患者尿微量白蛋白（MAU）的影响。方法此研究为随机双盲实验。将119名有微量白蛋白尿的原发性高血压患者随机分为贝那普利组（10mg/d,n=42）、缬沙坦组（160mg/d,n=37）和联合用药组（贝那普利5mg/d＋缬沙坦80mg/d,n=40）。半量治疗4周后能耐受者增加至目标剂量,随访4周。分别于研究开始、治疗4周、8周时测定MAU和血压。结果治疗8周后降压幅度为：贝那普利组〔n=35,（15.8±3.4）/（10.0±1.8）mmHg〕,缬沙坦〔n=35,（14.7±3.7）/（9.8±1.6）mmHg〕,联合用药组〔n=38,（15.3±3.6）/（10.2±1.4）mmHg〕,3组比较血压差异无统计学意义;MAU降低幅度为：贝那普利组〔（65.4±9.5）mg/24h〕,缬沙坦〔（67.8±11.5）mg/24h〕,联合用药组〔（95.8±12.2）mg/24h〕,联合用药组较单药组效果显著,P均〈0.01。结论缬沙坦和贝那普利联合用药较加大剂量单药治疗的血压控制无差异,但对高血压患者的肾脏保护作用更强。

The Effect of Combination Treatment of Benazepil and Valsartan on Microalbuminuria in Patient with Essential Hypertension

Objective To evaluate the effect of microalbuminuria of combined treatment with benazepil and valsartan,or benazepil,valsartan monotherapy in patient with essential hypertension.Methods In this double-blind,intention to treat study,119 patients with microalbuminuria and essential hypertension were randomly assigned to receive benazepil 10 mg/d（n=42）,valsartan 160 mg/d（n=37）,or a Combination of benazepil 5 mg and valsartan 80 mg（n=40） qd for 4 weeks,followed by titrating to the maximum recommended doses for another 4 weeks.The primary endpoint was the difference of mean sitting blood pressure and microalbuminuria at baseline and week 8.Results At week 8,the combination of benazepil and valsartan therapy lowered mean microalbuminuria from baseline by 95.8 mg/24h,significantly more than either monotherapy（benazepil 10mg,65.4 mg/24 h,P〈0.01 or valsartan 160 mg,67.8 mg/24 h P〈0.01）.Both SBP and DBP were not different among three groups.Conclusion Combination of ARB and ACEI at maximum recommended doses resulted in significantly more decrease in microalbuminuria and have better renal protective effects than monotherapy with either agent in patient with essential hypertension.