1例晚期慢性肾脏病合并难治性高血压患者ACEI/ARB应用的病例分析

田华, 张相林, 赵莉

中国药学杂志 ›› 2016, Vol. 51 ›› Issue (11) : 942-947.

PDF(772 KB)
中国药学杂志
PDF(772 KB)
中国药学杂志 ›› 2016, Vol. 51 ›› Issue (11) : 942-947. DOI: 10.11669/cpj.2016.11.016
论著

1例晚期慢性肾脏病合并难治性高血压患者ACEI/ARB应用的病例分析

  • 田华1, 2, 张相林1, 赵莉1*
作者信息 +

Use of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers (ACEI/ARB) in Patients with Resistant Hypertension and Advanced Chronic Kidney Disease:A Case Analysis

  • TIAN Hua1, 2, ZHANG Xiang-lin1, ZHAO Li 1*
Author information +
文章历史 +

摘要

目的 探讨晚期慢性肾脏病的高血压患者临床治疗中血管紧张素转化酶抑制剂/血管紧张素受体Ⅱ拮抗剂(ACEI/ARB)应用的有效性和安全性。方法 通过1例慢性肾脏病4期难治性高血压患者的降压治疗方案调整,结合最新指南推荐及临床试验,总结、分析ACEI/ARB在真实世界中治疗晚期慢性肾脏病合并高血压患者的实际应用现状。结果 与结论 晚期慢性肾脏病的高血压患者中ACEI/ARB临床应用的有效性和安全性存在不确定性,应谨慎使用ACEI/ARB。针对该年轻患者小剂量应用血管紧张素受体Ⅱ拮抗剂是合理的,但医师和药师需以合作形式持续、密切关注血肌酐和血钾水平、迟发性肾功能衰竭的发生。

Abstract

OBJECTIVE To discuss the efficacy and safety of agiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in patients with resistant hypertension and advanced chronic kidney disease. METHODS The treatment of resistant hypertension in one patient with chronic kidney disease (stage 4) was analyzed. According to the latest guidelines and clinical trials, actual treatment situation was summarized and analyzed. RESULTS AND CONCLUSION The efficacy and safety of ACEIs or ARBs in patients with advanced chronic kidney disease and hypertension remain uncertain, thus, cautions should be exercised. It′s reasonable to use low dose ARBs for such a young patient, nevertheless, it is emphasised that pharmacists and physicians should regularly and constantly monitor the patients′ serum levels of creatinine and potassium and late-onset renal failure resulted from angiotensin blockade in patients on ACEIs/ARBs in a collaborative way.

关键词

血管紧张素转化酶抑制剂/血管紧张素受体Ⅱ拮抗剂(ACEI/ARB) / 晚期慢性肾脏病 / 高血压 / 终末期肾病 / 蛋白尿

Key words

angiotensin-converting enzyme inhibitor, angiotensin receptor blocker (ACEI/ARB) / advanced chronic kidney disease / hypertension / end stage renal disease / proteinuria

引用本文

EndNote

Ris (Procite)

Bibtex

导出引用
田华, 张相林, 赵莉. 1例晚期慢性肾脏病合并难治性高血压患者ACEI/ARB应用的病例分析[J]. 中国药学杂志, 2016, 51(11): 942-947 https://doi.org/10.11669/cpj.2016.11.016
TIAN Hua, ZHANG Xiang-lin, ZHAO Li. Use of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers (ACEI/ARB) in Patients with Resistant Hypertension and Advanced Chronic Kidney Disease:A Case Analysis[J]. Chinese Pharmaceutical Journal, 2016, 51(11): 942-947 https://doi.org/10.11669/cpj.2016.11.016
中图分类号： R969.3   

参考文献

[1] VAN D M V, WIELDERS H P, GROOTENDORST D C, et al. Chronic kidney disease in patients with diabetes mellitus type 2 or hypertension in general practice [J]. Br J Gen Pract, 2010, 60 (581):884-890.
[2] LASH J P, GO A S, APPEL L J, et al. Chronic Renal Insufficiency Cohort (CRIC) Study:baseline characteristics and associations with kidney function [J]. Clin J Am Soc Nephrol, 2009, 4 (8):1302-1311.
[3] LIU M, LI X C, LU L, et al. Cardiovascular disease and its relationship with chronic kidney disease [J]. Eur Rev Med Pharmacol Sci, 2014, 18 (19):2918-2926.
[4] LEONCINI G, VIAZZI F, PONTREMOLI R. RAAS inhibition and renal protection [J]. Curr Pharm Des, 2012, 18 (7):971-980.
[5] FOLEY R N, MURRAY A M, LI S, et al. Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999 [J]. J Am Soc Nephrol, 2005, 16 (2):489-495.
[6] PERALTA C A, NORRIS K C, LI S, et al. Blood pressure components and end-stage renal disease in persons with chronic kidney disease:the Kidney Early Evaluation Program (KEEP) [J]. Arch Intern Med, 2012, 172 (1):41-47.
[7] MANN J F, RITZ E, KUNZ R. Renoprotective effects of renin-angiotensin-system inhibitors [J]. Lancet, 2006, 367 (9514):900-902.
[8] JAMES P A, OPARIL S, CARTER B L, et al. 2014 evidence-based guideline for the management of high blood pressure in adults:report from the panel members appointed to the Eighth Joint National Committee (JNC 8) [J]. JAMA, 2014, 311 (5):507-520.
[9] WEBER M A, SCHIFFRIN E L, WHITE W B, et al. Clinical practice guidelines for the management of hypertension in the community:a statement by the American Society of Hypertension and the International Society of Hypertension [J]. J Clin Hypertens (Greenwich), 2014, 16 (1):14-26.
[10] DASGUPTA K, QUINN R R, ZARNKE K B, et al. The 2014 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension [J]. Can J Cardiol, 2014, 30 (5):485-501.
[11] ESH/ESC TASK FORCE FOR THE MANAGEMENT OF ARTERIAL HYPERTENSION. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC):ESH/ESC Task Force for the Management of Arterial Hypertension [J]. J Hypertens, 2013, 31 (10):1925-1938.
[12] CHIANG C E, WANG T D, UENG K C, et al. 2015 guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the management of hypertension [J]. J Chin Med Assoc, 2015, 78 (1):1-47.
[13] LIU L S. Revision committee of Chinese guidelines for the management of hypertension in the community. Chinese guidelines for the management of hypertension in the community (2014 revised edition) [J]. Chin J Hypertens(中华高血压杂志), 2015,23(1):24-43.
[14] SHIMAMOTO K, ANDO K, FUJITA T, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2014) [J]. Hypertens Res, 2014, 37 (4):253-390.
[15] TALER S J, AGARWAL R, BAKRIS G L, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for management of blood pressure in CKD [J]. Am J Kidney Dis, 2013, 62 (2):201-213.
[16] RUGGENENTI P, PERNA A, REMUZZI G. ACE inhibitors to prevent end-stage renal disease:when to start and why possibly never to stop:a post hoc analysis of the REIN trial results. Ramipril Efficacy in Nephropathy [J]. J Am Soc Nephrol, 2001, 12 (12):2832-2837.
[17] HOU F F, ZHANG X, ZHANG G H, et al. Efficacy and safety of benazepril for advanced chronic renal insufficiency [J]. N Engl J Med, 2006, 354 (2):131-140.
[18] HOU F F, XIE D, ZHANG X, et al. Renoprotection of Optimal Antiproteinuric Doses (ROAD) Study:a randomized controlled study of benazepril and losartan in chronic renal insufficiency [J]. J Am Soc Nephrol, 2007, 18 (6):1889-1898.
[19] BAKRIS G L, WEIR M R. Angiotensin-converting enzyme inhibitor-associated elevations in serum creatinine:is this a cause for concern? [J]. Arch Intern Med, 2000, 160 (5):685-693.
[20] PARK M, HSU C Y. An ACE in the hole for patients with advanced chronic kidney disease? [J]. JAMA Intern Med, 2014, 174 (3):355-356.
[21] SINHA A D, AGARWAL R. Hypertension treatment for patients with advanced chronic kidney disease [J]. Curr Cardiovasc Risk Rep, 2014, 8 (10):1-6.
[22] PARVING H H, SMIDT U M, HOMMEL E, et al. Effective antihypertensive treatment postpones renal insufficiency in diabetic nephropathy [J]. Am J Kidney Dis, 1993, 22 (1):188-195.
[23] NATIONAL INSTITUTES OF HEALTH. Landmark NIH study shows intensive blood pressure management may save lives. [EB/OL]. NIH, 2015 [2015-9-11]. http://www. nih. gov/news/health/sep2015/nhlbi-11. htm
[24] AGARWAL R, SINHA A D. Thiazide diuretics in advanced chronic kidney disease [J]. J Am Soc Hypertens, 2012, 6 (5):299-308.
[25] SUN N L, HUO Y, WANG J G, et al. Chinese guidelines for the management of resistant hypertension [J]. Chin J Hypertens(中华高血压杂志), 2013, 21(4):321-326.
[26] TOTO R D. Management of hypertensive chronic kidney disease:role of calcium channel blockers [J]. J Clin Hypertens (Greenwich), 2005, 7 (4 suppl 1):15-20.
[27] TYLICKI L, LARCZYNSKI W, RUTKOWSKI B. Renal protective effects of the renin-angiotensin-aldosterone system blockade:from evidence-based approach to perspectives [J]. Kidney Blood Press Res, 2005, 28 (4):230-242.
[28] NODA M, FUKUDA R, MATSUO T, et al. Effects of candesartan cilexetil (TCV-116) and enalapril in 5/6 nephrectomized rats [J]. Kidney Int Suppl, 1997, 63:S136-S139.
[29] OTS M, MACKENZIE H S, TROY J L, et al. Effects of combination therapy with enalapril and losartan on the rate of progression of renal injury in rats with 5/6 renal mass ablation [J]. J Am Soc Nephrol, 1998, 9 (2):224-230.
[30] CAO X H, GAO Z L, YANG Y. Therapeutic mechanism of angiotensin II receptor blockers and their clinical application in the treatment of hypertension combining renal disfunction [J]. World Clin Drugs (世界临床药物), 2010,31(1):48-51.
[31] BRENNER B M, COOPER M E, DE ZEEUW D, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy [J]. N Engl J Med, 2001, 345 (12):861-869.
[32] LEWIS E J, HUNSICKER L G, CLARKE W R, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes [J]. N Engl J Med, 2001, 345 (12):851-860.
[33] JAFAR T H, SCHMID C H, LANDA M, et al. Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data [J]. Ann Intern Med, 2001, 135 (2):73-87.
[34] JAFAR T H, STARK P C, SCHMID C H, et al. Progression of chronic kidney disease:the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition:a patient-level meta-analysis [J]. Ann Intern Med, 2003, 139 (4):244-252.
[35] HSU T W, LIU J S, HUNG S C, et al. Renoprotective effect of renin-angiotensin-aldosterone system blockade in patients with predialysis advanced chronic kidney disease, hypertension, and anemia [J]. JAMA Intern Med, 2014, 174 (3):347-354.
[36] ONUIGBO M A. Can ACE inhibitors and angiotensin receptor blockers be detrimental in CKD patients? [J]. Nephron Clin Pract, 2011, 118 (4):407-419.
[37] AHMED A K, KAMATH N S, MOHSEN E K, et al. The impact of stopping inhibitors of the renin-angiotensin system in patients with advanced chronic kidney disease [J]. Nephrol Dial Transplant, 2010, 25 (12):3977-3982.
[38] ONUIGBO M A. Is renoprotection with RAAS blockade a failed paradigm? Have we learnt any lessons so far? [J]. Int J Clin Pract, 2010, 64 (10):1341-1346.
[39] ONUIGBO M A, ONUIGBO N T. Late-onset renal failure from angiotensin blockade (LORFFAB) in 100 CKD patients [J]. Int Urol Nephrol, 2008, 40 (1):233-239.
[40] BHANDARI S, IVES N, BRETTELL E A, et al. Multicentre randomized controlled trial of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker withdrawal in advanced renal disease:the STOP-ACEi trial [J]. Nephrol Dial Transplant, 2016,31(2):255-261.
[41] MORANN O, FROISSART M, ROSSERT J, et al. Timing of onset of CKD-related metabolic complications [J]. J Am Soc Nephrol ,2009,20(1):164-171.
[42] WANG H H, HUNG C C, HWANG D Y, et al. Hypokalemia, its contributing factors and renal outcomes in patients with chronic kidney disease [J]. PLoS One, 2013, 8 (7):e67140.
[43] SUSANTITAPHONG P, SEWARALTHAHAB K, BALK E M, et al. Efficacy and safety of combined vs. single renin-angiotensin-aldosterone system blockade in chronic kidney disease:a meta-analysis [J]. Am J Hypertens, 2013, 26 (3):424-441.

基金

国家自然科学基金资助项目(81401507);中日友好医院2014年院级科研基金资助项目(2014-2-QN-18)
PDF(772 KB)

Accesses

Citation

Detail
段落导航
相关文章

/

〈 〉