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薬理と治療
Abstract
In 2008, irbesartan(IRBETAN_Tablet), an angiotensin II receptor blocker(ARB),became available in Japan. Diabetic nephropathy is one of the main causes of death in diabeticpatients. Irbesartan is reported to reduce blood pressures as well as albuminuria in hypertensivediabetic patients in Western countries, but little information is available in Japan. Thepurpose of this study is to investigate the effect of irbesartan as monotherapy, or in combinationwith cilnidipine on blood pressures, albuminuria and adverse reactions in Japanese hypertensivediabetic patients.Thirteen patients with hypertension and type 2 diabetes(male n=9, female n=4)werestudied for irbesartan monotherapy. Twenty six patients with hypertension and type 2 diabetes(male n=13, female n=13)were studied for combination therapy with irbesartan andcilnidipine. All patients were under stable glycemic control. All patients had normal liverfunctions. Systolic(SBP)and diastolic(DBP)blood pressures were measured, and albuminuriawas assessed with urinary albumin excretion index(UAI, mg/g creatinine, normal range<30mg/g creatinine).Irbesartan(100 mg/day after breakfast)was administered over 12 weeks. It significantlyreduced SBP by 17.6%(153→126 mmHg), DBP by 13.4%(82→71 mmHg), and UAI by52.8%(180→85 mg/g creatinine). Irbesartan(100 mg/day after breakfast)and cilnidipine(10 mg/day after breakfast)was administered over 12 weeks. It significantly reduced SBP by22.6%(164→127 mmHg), DBP by 15.3%(87→65 mmHg), and UAI by 70.2%(322→96 mg/g creatinine). HbA1c was not changed before and after the treatment. Serum ALT, AST,γ−GTP, uric acid, potassium and creatinine were not changed before and after the treatment,and no adverse reactions were observed over the study period.It is concluded that irbesartan monotherapy is effective to reduce not only blood pressuresbut also albuminuria in Japanese hypertensive diabetic patients. In addition, combinationtherapy with irbesartan and cilnidipine is more effective. Irbesartan is suggested to protectdiabetic nephropathy because of its great reduction of albuminuria.(Jpn Pharmacol Ther 2010;38:173−8)KEY WORDS Irbesartan, Microalbuminuria, Macroalbuminuria, Diabetic nephropathy,Hypertension, Cilnidipine
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