Комбинация лерканидипина и блокаторов ренинангиотензиновой системы в лечении пациентов с протеинурией

Цель. Большинство антагонистов кальция (АК) не обладают способностью уменьшать микроальбуминурию и протеинурию. Предпринята попытка оценить антипротеинурический эффект нового АК лерканидипина у пациентов, которым ранее было назначено лечение ИАПФ либо БРА.
Дизайн и методы. В исследование вошли 68 больных с протеинурией (>500 мг/сут), в т.ч. 69,1 % мужчин и 30,9 % женщин (средний возраст 63,1±12,9 лет). Несмотря на начатый ранее прием ИАПФ (51,4 %) либо БРА (48,6 %), артериальное давление (АД) у всех участников превышало целевые уровни для больных с протеинурией (<130/80 мм рт.ст.). Клиническое обследование пациентов, в т.ч. анализ крови и мочи, выполнялось через 1, 3 и 6 мес. от начала терапии лерканидипином (20 мг/сут.). При необходимости, к лечению добавляли третий антигипертензивный препарат. Клиренс креатинина (ККр) рассчитывали по результатам анализа суточной мочи.
Результаты. Через 6 мес. наблюдения отмечалось достоверное снижение уровней АД со 152±15/86±11 мм рт.ст. до 135±12/77±10 мм рт.ст. (р<0,001). Доля пациентов с нормализацией АД (<130/80 мм рт.ст.) составила 42,5 %. У 58,8 % участников АД < 140/90 мм рт.ст. Концентрация Кр плазмы существенно не менялась, как и ККр. Уровень холестерина плазмы снизился с 210±48 до 192±34 мг/дл (р<0,001); концентрация триглицеридов также снизилась со 151±77 до 134±72 мг/дл (р=0,022). Исходный уровень протеинурии составлял 1,63±1,34 г/сут. Через 1 мес. лечения он достоверно (р<0,001) снизился на 23 %; через 3 и 6 мес. снижение составило 37 % и 33 %, соответственно.
Заключение. Лерканидипин в дозе 20 мг/сут. в сочетании с блокаторами ренин-ангиотензиновой системы обладает выраженным антигипертензивным и антипротеинурическим эффектом. Антипротеинурический эффект лерканидипина, по-видимому, является дозозависимым и относительно более выраженным, чем антигипертензивное действие этого препарата.

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