[ESC2010]CCB与RAS抑制剂联合治疗预防高血压慢性肾病和动脉粥样硬化进展The impact of CCB and RAS inhibitor combination therapy to prevent CKD incidence in hypertension and advanced atherosclerosis
背景：众所周知，动脉粥样硬化和高血压与慢性肾脏病（CKD）有关。然而，抗高血压药物预防CKD发生的有效性尚未被证实。我们研究了在高血压合并晚期动脉粥样硬化患者中抗高血压药物对预防CKD的影响。
方法：在连续693例2006~2007年接受高血压治疗、eGFR≥60 ml/min/1.73m2且接受心-踝血管指数评价的患者中，我们随访了CKD的发生率（eGFR<60 ml/min/1.73m2或蛋白尿）。
结果：随访期间（29±10个月），研究者发现291例患者发生了CKD，并且发现了CKD与 CAVI间的关联。我们利用ROC曲线将269例CAVI≥9.0的患者定义为患有晚期动脉粥样硬化。晚期动脉粥样硬化组有145例CKD发生，62例（62.6%）CKD是发生在99例接受肾素-血管紧张素抑制剂（RAS抑制剂；ACE抑制剂、ARB等）单药治疗的患者中；59例（50.9%）发生在116例接受钙通道阻滞剂（CCB）和RAS抑制剂联合治疗的患者中。年龄和性别校正后，CCB和RAS抑制剂联合治疗相对RAS抑制剂单药治疗CKD发生的比值比为0.58（95%CI：0.33~1.01）。多变量（年龄、性别、血压、他汀和磺脲类药物）校正后的比值比为0.55（95%CI：0.31~0.97）。
结论：研究者建议，与RAS抑制剂单药治疗相比，在高血压合并晚期动脉粥样硬化且无CKD的患者中，CCB和RAS抑制剂联合治疗可有效预防CKD发生。
The impact of CCB and RAS inhibitor combination therapy to prevent CKD incidence in hypertension and advanced atherosclerosis
Background: Atherosclerosis and hypertension has been known to relate to chronic kidney disease (CKD). Howerver， to prevent CKD incidence， the efficacy of antihypertensive drug has not been confirmed. We investigated the impact of antihypertensive drug to prevent CKD incidence in hypertensive patients with advanced atherosclerosis.
Methods: In consecutive 693 patients with hypertensive treatment and eGFR≥60 ml/min/1.73m2 undergoing cardio-ankle vascular index (CAVI) from 2006 to 2007， we followed CKD incidences (eGFR<60 ml/min/1.73m2 or proteinuria).
Results: During follow-up periods (29±10months)， we found 291 CKD incidences and relationship between CKD incidence and CAVI. We defined 269 patients with CAVI≥9.0 as advanced atherosclerosis using ROC curve. In advanced atherosclerosis group， we found 145 CKD incidences， 62 CKD incidences (62.6%) in 99 patients with renin angiotensin inhibitor (RAS inhibitor; ACE inhibitor， ARB， et al.) single therapy， 59 CKD incidences (50.9%) in 116 patients with calcium channel blocker (CCB) and RAS inhibitor combination therapy. The age- and sex-adjusted odds ratio of CCB and RAS inhibitor combination therapy to RAS inhibitor single therapy for CKD incidence was 0.58 (95%CI:0.33-1.01). The multivariate-adjusted odds ratio was 0.55 (95%CI:0.31-0.97)， adjusted for age， sex， blood pressure， statin， and SU.
Conclusion: We suggest that CCB and RAS inhibitor combination therapy is effective to prevent CKD incidence in comparison with RAS inhibitor single therapy in patients with hypertension and advanced atherosclerosis without CKD.