Advance of research on application of renin-angiotensin-aldosterone system blockers in elderly patients with chronic kidney disease

doi:10.3877/cma.j.issn.2095-3216.2014.02.006

Abstract

Abstract:

The proportion of global older people (age≥65 years) is gradually increasing. Because of their special physiological state, older people are more easily troubled by some chronic diseases such as hypertension, diabetes, and chronic kidney disease (CKD). Overactivity of renin-angiotensin-aldosterone system(RAAS) can lead to hypertension, cardiovascular events, as well as CKD. Therefore, the treatment targeting RAAS is feasible. However, while using RAAS blockers including angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), renin inhibitors, and aldosterone antagonists,elderly patients are more likely to be subjected to decrease of glomerular filtration rate (GFR),hyperkalemia, and hypotension, etc, indicating that it is specially required to weigh the pros and cons before clinical use of such drugs. Although most limited researches on efficacy of RAAS blocker drugs in elderly patients obtained positive conclusions, more long-term studies are still needed to explore the therapeutic efficacy and safety of RAAS blockers in elderly patients with CKD, and to confirm the effect of RAAS blockers in slowing the progression of CKD.

Key words: Renin-angiotensin-aldosterone system blockers, Elderly, Chronic kidney disease

Qi Zhang, Zhaohui Ni. Advance of research on application of renin-angiotensin-aldosterone system blockers in elderly patients with chronic kidney disease[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2014, 03(02): 82-90.

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References 77

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研究者	试验设计	患者特点	干预方法	结果	副作用
Wing等^[31]	多中心、开放性、随机	老年高血压患者(年龄65～84岁)	ACEI(n=3044)或利尿剂(3039),中位随访4.1年	ACEI组心血管预后较好,血压下降相似	未报道
Lacourcière^[32]	多中心、双盲、随机	老年轻、中度高血压患者(年龄＞65岁)	使用厄贝沙坦150mg/d(n=70)或依那普利10mg/d(n=71)8周	收缩压及舒张压在第8周下降相似	与基线相比或组间肾脏变量均无明显变化
Pitt等^[38]	多中心、双盲、随机	NYHAⅡ～Ⅳ级的老年心衰患者(年龄＞65岁)	氯沙坦钾增至50mg/d(n=352)或卡托普利增至50mg/d(n=370),3次/d,持续48周	两组持续血清肌酐上升发生率相同(10.5%)	氯沙坦钾组因副作用而停止治疗的患者少
Lithell等^[34]	多中心、双盲、随机	老年2级高血压患者(年龄70～89岁)	坎地沙坦8mg/d(n=2477)或对照(n=2460),平均随访3.7年	两组主要心血管事件无差别	两组相似
Winkelmayer等^[39]	析因分析	2型糖尿病老年患者(年龄＞65岁)	氯沙坦钾50mg(如需要加至100mg,n=204)或安慰剂(n=217),平均随访3.4年	与安慰剂相比,氯沙坦钾组的终末期肾脏病事件发生率下降50%	两组相似

研究者	试验设计	患者特点	干预方法	结果	副作用
Wing等^[31]	多中心、开放性、随机	老年高血压患者(年龄65～84岁)	ACEI(n=3044)或利尿剂(3039),中位随访4.1年	ACEI组心血管预后较好,血压下降相似	未报道
Lacourcière^[32]	多中心、双盲、随机	老年轻、中度高血压患者(年龄＞65岁)	使用厄贝沙坦150mg/d(n=70)或依那普利10mg/d(n=71)8周	收缩压及舒张压在第8周下降相似	与基线相比或组间肾脏变量均无明显变化
Pitt等^[38]	多中心、双盲、随机	NYHAⅡ～Ⅳ级的老年心衰患者(年龄＞65岁)	氯沙坦钾增至50mg/d(n=352)或卡托普利增至50mg/d(n=370),3次/d,持续48周	两组持续血清肌酐上升发生率相同(10.5%)	氯沙坦钾组因副作用而停止治疗的患者少
Lithell等^[34]	多中心、双盲、随机	老年2级高血压患者(年龄70～89岁)	坎地沙坦8mg/d(n=2477)或对照(n=2460),平均随访3.7年	两组主要心血管事件无差别	两组相似
Winkelmayer等^[39]	析因分析	2型糖尿病老年患者(年龄＞65岁)	氯沙坦钾50mg(如需要加至100mg,n=204)或安慰剂(n=217),平均随访3.4年	与安慰剂相比,氯沙坦钾组的终末期肾脏病事件发生率下降50%	两组相似

研究者	试验设计	患者特点	干涉	结果	副作用
Verdecchia等^[54]	多中心、双盲、随机	年龄＞65岁的高血压患者	阿利吉仑75mg(n=91),150mg(n=84)或300mg(n=94)或赖诺普利10mg(n=86)	与基线相比所有治疗组血压均有效降低	副作用发生与剂量无正相关
Schmieder等^[57]	析因分析	年龄＞65岁的高血压患者	阿利吉仑300mg(n=145),氢氯噻嗪25mg(n=144)52周	阿利吉仑组降低收缩压更有效	阿利吉仑耐受性好
Duprez等^[56]	多中心、双盲、随机	年龄＞65岁的高血压患者	每日(随需要调整剂量)使用阿利吉仑150mg(n=457)或雷米普利5mg(n=444)36周	两组降低收缩压的效果相似	两组发生副作用或严重事件无明显差异

研究者	试验设计	患者特点	干涉	结果	副作用
Verdecchia等^[54]	多中心、双盲、随机	年龄＞65岁的高血压患者	阿利吉仑75mg(n=91),150mg(n=84)或300mg(n=94)或赖诺普利10mg(n=86)	与基线相比所有治疗组血压均有效降低	副作用发生与剂量无正相关
Schmieder等^[57]	析因分析	年龄＞65岁的高血压患者	阿利吉仑300mg(n=145),氢氯噻嗪25mg(n=144)52周	阿利吉仑组降低收缩压更有效	阿利吉仑耐受性好
Duprez等^[56]	多中心、双盲、随机	年龄＞65岁的高血压患者	每日(随需要调整剂量)使用阿利吉仑150mg(n=457)或雷米普利5mg(n=444)36周	两组降低收缩压的效果相似	两组发生副作用或严重事件无明显差异

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