Amlodipine-chlorthalidone provided similar BP reduction to amlodipine-torsemide but yielded greater ACR reduction (119.7 vs 88.7 mg/g; P=0.021) and slower eGFR decline (P=0.043).
RCT (n=90)
randomly assigned
No
Does amlodipine + chlorthalidone improve renal and blood pressure outcomes compared to amlodipine + torsemide in adults with hypertensive chronic kidney disease?
In hypertensive patients with CKD, the combination of amlodipine and chlorthalidone provides superior renoprotection compared to amlodipine and torsemide, despite similar blood pressure control.
Abstract Background: Hypertension commonly coexists with chronic kidney disease (CKD), accelerating renal decline and increasing cardiovascular risk. Optimal blood pressure (BP) control is crucial to prevent CKD progression. Among antihypertensives, calcium channel blockers and diuretics are key components. This study compared the efficacy and renal safety of two combinations – amlodipine–torsemide and amlodipine–chlorthalidone – in hypertensive CKD patients. Materials and Methods: A prospective, observational, comparative study was conducted over 12 months among 90 adults with CKD (estimated glomerular filtration rate eGFR: 30–90 mL/min/1.73 m 2 ) and hypertension. Participants were randomly assigned to receive either amlodipine + torsemide (Group A) or amlodipine + chlorthalidone (Group B). Primary endpoints included changes in systolic BP (SBP) and diastolic BP, eGFR, and urine albumin-to-creatinine ratio (ACR). Data were analyzed using SPSS v22, with statistical significance set at P < 0.05. Results: Both the regimens produced significant BP reductions from baseline ( P < 0.001) with no intergroup difference (mean SBP fall: 23.0 ± 3.7 vs. 24.5 ± 4.1 mmHg; P = 0.18). The chlorthalidone group showed a significantly greater reduction in ACR (119.7 ± 17.6 vs. 88.7 ± 14.8 mg/g; P = 0.021) and a slower decline in eGFR (−7.3 ± 3.1 vs. −10.2 ± 2.8 mL/min/1.73 m 2 ; P = 0.043), suggesting superior renal preservation. Ultrasonographic kidney dimensions remained unchanged, and adverse effects were mild and comparable. Conclusion: Both the combinations effectively controlled BP in hypertensive CKD, but amlodipine–chlorthalidone offered better renoprotective benefits without added safety concerns. Larger multicentric trials are recommended to confirm these findings.
Mazumdar等人（周四）在高血压慢性肾病中进行了RCT（n=90）。评估氨氯地平-氯噻噁吨与氨氯地平-噻噻米在收缩压(SBP)、舒张压、eGFR和尿白蛋白与肌酐比率(ACR)的变化。氨氯地平-氯噻噁吨提供与氨氯地平-噻噻米相似的血压降低，但得到更大的ACR减少（119.7对88.7 mg/g；P=0.021）和更慢的eGFR下降（P=0.043）。