高血圧性腎硬化症における腎的アウトカムに対するラミプリルとアムロディピンの効果:ランダム化制御試験
L Y Agodoa1, L Appel, G L Bakris
1Case Western Reserve University, Clinical Hypertension Program, University Hospitals of Cleveland and the Louis Stokes Cleveland Veterans Affairs Medical Center, 10900 Euclid Ave, Wood Bldg Room W-165, Cleveland, OH 44106-4982, USA. jxw20@po.cwru.edu
JAMA
|June 21, 2001
まとめ
ラミプリルは,プロテイン尿を有する高血圧患者の腎臓機能低下を,アムロディピンと比較して著しく遅らせました. このACE阻害剤は,タンパク質尿のない患者にも有益であり,腎不全を予防するための新しい戦略を提供します.
科学分野:
- ネフロロジーは腎臓科
- 心臓病学 心臓病学
- 薬理学 薬理学とは
背景:
- 高血圧に起因する末期腎疾患は,特にアフリカ系アメリカ人の間で増加しています.
- 腎不全を予防するための最適の抗高血圧薬の戦略は不明である.
研究 の 目的:
- 高血圧性腎臓疾患の進行管理におけるラミプリル (ACE阻害剤),アムロディピン (カルシウムチャネルブロッカー),メトプロロール (ベータブロッカー) の有効性を比較する.
主な方法:
- 高血圧性腎臓疾患を持つ1094人のアフリカ系アメリカ人を対象としたランダム化,ダブルブラインド試験の暫定分析.
- 比較はラミプリルとアムロディピンのグループに焦点を当て,球フィルタレーション率 (GFR) と臨床エンドポイントの変化を評価した.
主要な成果:
- ラミプリルは,アムロジピンと比較して,タンパク質尿症の患者で,GFRの減少を36%大幅に遅らせ,臨床エンドポイントのリスクを48%減少させた.
- コーホート全体でGFR減少の全体的な差異は認められなかったが,ラミプリルは調整された分析で,臨床エンドポイントのリスクが低下し,タンパク質ウリアが減少したことを示した.
結論:
- ラミプリルは,タンパク質尿を有する高血圧患者の腎疾患の進行を遅らせます.
- ラミプリルは,タンパク質ウリアのない患者に利点をもたらす可能性があり,高血圧性腎疾患の進行を予防する上でその潜在的な役割を示唆しています.
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