(精编)【高血压精品英文课件】Hypertension and Kidney.pptVIP

Continued ramipril Switched to ramipril 2 Ruggenenti et al. Lancet 1998;352:1252-1256. REIN follow-up trial chronic nephropathy and proteinuria3g/day 25 30 35 40 45 Core study Follow-up trial GFR decline (mL/min/1.73m /month) -0.44ml/min per month -0.10ml/min per month -0.81ml/min per month -0.14ml/min per month AASK: ACEI vs CCB in Hypertensive Renal Disease Agodoa LY et al. JAMA. 2001;285:2719–2728. GFR Event, ESRD, or Death 25 20 15 10 5 0 0 3 12 24 36 Amlodipine Ramipril Cumulative Incidence, % Months P = 0.005 CCB arm terminated prematurely because ACEI and beta blocker demonstrated clear superiority Cardiovascular mortality Non-cardiovascular mortality Hans L. Hillege, et al., Circulation, 2002, 106:1777 End-organ damage and mortality in general population The Effect of Angiotensin-Converting Enzyme Inhibition on Diabetic Nephropathy 409 Type I diabetics ages 18-49 with nephropathy (U protein500 mg and S Cr 2.5) Prospective, double-blinded multicenter (30) trial randomized to captopril vs. placebo for 3 years Lewis EJ et al , New Engl J Med 329:1456-62, 1993 ACE Inhibition and Type I DM Nephropathy Lewis EJ et al, New Engl J Med 329:1456, 1993 3) These effects were independent of effects on blood pressure. If S Cr 1.5 mg/dl: Captopril reduced doubling of S Cr by 48% over 4 years. Captopril reduced ESRD(dialysis or transplant) or death by 50% over 4 years. Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan – RENAAL 1513 Type II diabetics with nephropathy (U alb/Cr ratio 300 or U prot 500 mg and S Cr 1.3-3.0 mg/dl) Prospective, randomized, double-blinded multicenter (250) trial Two arms – Losartan (50-100 mg) to keep BP140/90 vs. placebo for 3.4 years Brenner BM et al, New Engl J Med 345:861-869, 2001 RENAAL – ARB Reduction of Renal Failure Brenner BM et al, N Eng