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【文摘发布】替米沙坦与雷米普利对伴高血压的
Author：Schmieder RE, Delles C, Mimran A, Fauvel JP, Ruilope LM.
Resource: Diabetes Care. 2007 Mar 2; [Epub ahead of print]
Abstract：Background: One of the earliest signs of vascular change is endothelial dysfunction, which is also known to provoke albuminuria and to predict cardiovascular prognosis. The study aimed to analyze the effects of renin-angiotensin-system (RAS) blockade on renal endothelial function. Methods: In a multicenter, prospective, double-blind, forced-titration, randomized study, 96 patients with type 2 diabetes, hypertension, GFR >80 mL/min, and normo- or microalbuminuria were treated once daily with telmisartan 40/80 mg or ramipril 5/10 mg for 9 weeks. Results: The (mean +/- SE) fall in renal plasma flow (RPF) in response to intravenous N(G)-monomethyl-L-arginine (L-NMMA), reflecting the magnitude of nitric oxide (NO) activity, increased with telmisartan from 71.9 +/- 9.0 mL/min before therapy to 105.2 +/- 9.7 mL/min at end of treatment (p < 0.001). With ramipril, RPF response to L-NMMA increased from 60.1 +/- 12.2 mL/min to 87.8 +/- 9.2 mL/min (p = 0.018). The adjusted mean +/- SE difference between treatments was -17.1 +/- 13.7 mL/min (p = 0.214). In accordance, telmisartan increased RPF at rest (i.e., without L-NMMA) from 652.0 +/- 27.0 mL/min to 696.1 +/- 31.0 mL/min (p = 0.047), whereas ramipril produced no significant changes in RPF. The more the basal NO activity improved, the greater was the vasodilatory effect on renal vasculature (r = 0.47, p < 0.001). Conclusions: In patients with type 2 diabetes telmisartan and ramipril both increased NO activity of the renal endothelium significantly that in turn may support the preservation of cardiovascular and renal function.
PMID: 17337492 Title：Impact of Telmisartan Versus Ramipril on Renal Endothelial Function in Patients with Hypertension and Type 2 Diabetes.
替米沙坦和雷米普利对伴有高血压的2型糖尿病患者肾脏内皮功能影响的对比研究
作者：Schmieder RE, Delles C, Mimran A, Fauvel JP, Ruilope LM.
资料来源： Diabetes Care. 2007 Mar 2;
Abstract：Background: One of the earliest signs of vascular change is endothelial dysfunction, which is also known to provoke albuminuria and to predict cardiovascular prognosis. The study aimed to analyze the effects of renin-angiotensin-system (RAS) blockade on renal endothelial function.
背景：血管病变最早的表现之一就是内皮功能障碍，众所周知，它可以引起白蛋白尿并被用来预测心血管疾病的转归。本研究旨在探索阻断肾素－血管紧张素系统(RAS)对肾脏内皮功能的影响。
Methods: In a multicenter, prospective, double-blind, forced-titration, randomized study, 96 patients with type 2 diabetes, hypertension, GFR >80 mL/min, and normo- or microalbuminuria were treated once daily with telmisartan 40/80 mg or ramipril 5/10 mg for 9 weeks.
方法：在这项多中心、前瞻性、双盲、强制性剂量递增和随机性的研究中，符合下列条件的96例2型糖尿病患者接受了为期9周，每日一次40/80 mg替米沙坦或5/10 mg雷米普利治疗。这些条件包括：合并有高血压、肾小球滤过率>80 mL/min和正常或微量白蛋白尿。
Results: The (mean +/- SE) fall in renal plasma flow (RPF) in response to intravenous N(G)-monomethyl-L-arginine (L-NMMA), reflecting the magnitude of nitric oxide (NO) activity, increased with telmisartan from 71.9 +/- 9.0 mL/min before therapy to 105.2 +/- 9.7 mL/min at end of treatment (p < 0.001). With ramipril, RPF response to L-NMMA increased from 60.1 +/- 12.2 mL/min to 87.8 +/- 9.2 mL/min (p = 0.018). The adjusted mean +/- SE difference between treatments was -17.1 +/- 13.7 mL/min (p = 0.214). In accordance, telmisartan increased RPF at rest (i.e., without L-NMMA) from 652.0 +/- 27.0 mL/min to 696.1 +/- 31.0 mL/min (p = 0.047), whereas ramipril produced no significant changes in RPF. The more the basal NO activity improved, the greater was the vasodilatory effect on renal vasculature (r = 0.47, p < 0.001).
结果：静脉注射NG-单甲基左旋精氨酸(L-NMMA)后肾脏血流量(RPF)反应性的降低（反映一氧化氮活性的强度）在使用替米沙坦后从治疗前的71.9 +/- 9.0 mL/min升高到治疗结束时的105.2 +/- 9.7 mL/min(均值+/-标准误，p < 0.001)。而使用雷米普利后RPF从治疗前的60.1 +/- 12.2 mL/min 升高到治疗结束时的 87.8 +/- 9.2 mL/min (p = 0.018)。校正后两组间差异为-17.1 +/- 13.7 mL/min (p = 0.214)。在静息状态下（未注射L-NMMA），替米沙坦可使RPF从652.0 +/- 27.0 mL/min升高到 696.1 +/- 31.0 mL/min (p = 0.047)，而雷米普利对RPF则没有显著影响。 对基础NO活性改善越多，对肾脏血管的扩张作用越强（相关系数= 0.47, p < 0.001)。
Conclusions: In patients with type 2 diabetes telmisartan and ramipril both increased NO activity of the renal endothelium significantly that in turn may support the preservation of cardiovascular and renal function.
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作者:admin@医学,生命科学 2011-01-25 05:14
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