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To investigate the protective effect of Astragalus membranaceus on renal damage in patients with hypertension and metabolic syndrome (MS).One hundred and nineteen patients of hypertension with MS were randomly divided into control group, Astragalus small dose group and Astragalus large dose group in a randomized controlled clinical study. The control group was given routine medical treatment, Astragalus groups were given astragalus extract tablets for 10 g/d or 5 g/d on the basis of routine medical treatment respectively. Waist circumference, serum glucose and lipid, liver function, renal function, blood pressure, urinary microalbuminuria (MAU) and the levels of asymmetric dimethylarginine were determined at baseline, sixth months and twelfth months respectively.After the treatment of Astragalus membranaceus for twelve months, there was no significant difference between the treatment group and the control group in MS components. The urine microalbuminuria reduced in the high and low dose groups of Astragalus membranaceus after six months (10.79 ± 2.80 VS 11.23 ± 2.99) and twelve months (8.42 ± 2.46 VS 8.61 ± 2.60) (P < 0.05), but the estimated glomerular filtration rate was not changed (P > 0.05); Compared with before treatment, the asymmetric dimethylarginine of high and low dose group of Astragalus membranaceus reduced after twelve months (0.63 ± 0.23 VS 0.63 ± 0.25) (P < 0.05), but the effect was not observed at six months (P > 0.05).The one year use of Astragalus in small doses may play a better role in the protection of renal damage in patients of hypertension with MS.