慢性肾脏病诊治新常态分析.ppt

* * 阻断RAS对控制血压是非常有效的。这里显示的是Losartan和依那普利。可以看到，应用Losartan50mg/天，可以使血压下降10mmHg，增加至100mmHg可以继续下降一些，停药后恢复原先水平。用依那普利10mg/天，血压下降也是10mmHg左右，加量至20mg/天也会使血压有进一步下降，程度较Losartan相似，因此ACEI和ARB在控制血压方面的作用是相似的。 * * * Ang I and Ang II levels in renal interstitial fluid, plasma, and kidneys in which microdialysis probes were implanted in anesthetized rats (n=7). Renal interstitial concentrations of Ang I and Ang II were calculated based on equilibrium rates determined in vitro. * * The DIOVAN Reduction of Proteinuria (DROP) study assessed whether high doses of valsartan were superior to conventional doses for reducing urinary albumin excretion rates (UAER) in patients with Type 2 diabetes. Patients (n=391) with hypertension, Type 2 diabetes and UAER 20–700 μg/min were randomized to 160, 320 or 640 mg of valsartan for 30 weeks. All patients received valsartan 160 mg for the first 4 weeks. The dose was then increased in two of the three groups for the remainder of the study. Valsartan 160 mg induced a significant reduction in albuminuria from baseline to Week 4 (p0.01), which did not differ significantly between the three groups. Following the initiation of the assigned dose at Week 4, important dose-related differences in UAER emerged. Patients randomized to valsartan 320 mg and 640 mg showed a highly significant reduction in UAER at Week 16, which was maintained at Week 30 (p0.01 for both 640 mg and 320 mg versus Week 4). In contrast, patients who stayed on the valsartan 160 mg dose for the duration of the study showed only a modest incremental fall in UAER. In the 108 patients achieving target BP 30/80mmHg, greater and statistically significant albuminuria reductions also occurred with valsartan 640mg versus 160 mg during Weeks 0–30 (p0.05). In the overall study population, patients achieved normalization of UAER (20 μg/min) more frequently with valsartan 320 mg and 640 mg than with valsartan 160 mg. Reference: Hollenberg NK, et al. Albuminuria response to very high-dose valsarta