有效保护肾脏的抗高血压药物-替米沙坦.pptVIP

高血压病程不同阶段的治疗目标 疾病早期 预防疾病进展和逆转靶器官结构损害 疾病中晚期 预防心血管临床事件 K/DOQI 临床实践指南 高水平的蛋白尿与肾脏疾病的快速 展和心血管疾病的危险增加密切相关 JNC 7 推荐 以ARB或ACEI为基础的治疗方案对糖尿病肾病的进展和减少蛋白尿可起到有利的作用，同时ARB也被证明可延缓微量蛋白尿的进展 无论是JNC7还是DOQI关于CKD（慢性肾衰竭）的指南，都指出ARB可以有效延缓非糖尿病肾病进展 ADA (美国糖尿病协会)治疗指南 2型糖尿病伴高血压患者伴微量蛋白尿 ARB 可延缓进展至大量蛋白尿 2型糖尿病伴高血压、大量蛋白尿、肾功能不全 ARB可延缓肾病进展 微量白蛋白 意义： 糖尿病和非糖尿病病人肾脏和心血管预后的标志作为危险性分层分析的指标 微量白蛋白尿人群的潜在危险 心血管疾病 总死亡率 中风 肾脏疾病进展 其它 控制血压和蛋白尿是延缓CKD的关键 降低血压 降低蛋白尿 微量白蛋白尿 大量蛋白尿 ARB新的适应症： 腹膜透析患者有利于残余肾功能保护 肾移植患者可减少慢性排异的发生 * Unlike other ARBs, only 1% of a telmisartan dose in excreted by the kidney.1 Up to 50% of the dose of other ARBs is excreted by the kidney.1 Renal impairment is unlikely to affect the pharmacokinetics of telmisartan. Song JC, White CM. Olmesartan medoxomil (CS-866). An angiotensin II receptor blocker for treatment of hypertension. Formulary 2001;36:487–499. * * * TRENDY研究同样比较了替米沙坦对肾血流和肾血管阻力的影响，替米沙坦能提高肾血流、降低肾血管阻力。 The TRENDY study also compared renal plasma flow and renal vascular resistance at rest (i.e. without stimulation by infusion of L-NMMA.1 Telmisartan significantly improved renal plasma flow and decreased vascular resistance. Ramipril did not significantly change these parameters. Schmieder RE, et al. Effects of telmisartan versus ramipril on renal endothelial function in Type-2 diabetes. Presented at the XVIth Scientific Meeting of the Interamerican Society of Hypertension. Cancún, México, April 17–21, 2005. * TRENDY 比较了静息时肾血流量和肾血管阻力 替米沙坦能明显改善这些参数. 伊纳普利并不能显著改善这些参数 Schmeider RE, et al. Effects of telmisartan versus ramipril on renal endothelial function in Type-2 diabetes. Presented at the XVIth Scientific Meeting of the Interamerican Society of Hypertension. Cancún, México, April 17–21, 2005. * 对92名高血压伴蛋白尿（＞1g/24h）的患者应用替米沙坦，启始3个月用40mg，后4个月80mg，七个月后尿蛋白从3.61 g/24 h降至 0.76 g/24 h。 This 7-month study recruited 92 patients with hypertension (SBP/DBP 130/85 mmHg), serum creatinine 350 μmol/L and proteinuria 1 g/24 h. Sixty patients were diabetic. Telmisartan 40 mg/day was give