Objective. Most calcium antagonists do not seem to reduce microalbuminuria or proteinuria. We have tried to assess the antiproteinuric effect of a calcium channel blocker, lercanidipine, in patients previously treated with ACE inhibitors or angiotensin receptor blockers. Design and Methods. The study included 68 proteinuric (> 500 mg/day) patients (age 63.1 ± 12.9 years, 69.1% males and 30.9 females). All patients were receiving ACE inhibitors (51.4%) or angiotensin II receptor blockers (48.6%) therapy but had higher blood pressure than recommended for proteinuric patients (<130/80 mmHg). Patients were clinically evaluated one, three, and six months after starting treatment with lercanidipine (20 mg/day). Samples for urine and blood examination were taken during the examination. When needed, a third drug was added to treatment. Creatinine clearance was measured using 24 h urine collection. Results. BP significantly decreases from 152 ± 15/86 ± 11 mmHg to 135 ± 12/77 ± 10 mmHg at six months of follow-up (p < 0.001). After six months of treatment, the percentage of normalized patients (BP < 130/80 mmHg) was 42.5%, and the proportion of patients whose BP was below 140/ 90 mmHg was 58.8%. Plasmatic creatinine did not change nor did creatinine clearance. Plasmatic cholesterol also decreased from 210 ± 48 to 192 ± 34 mg/dL (p < 0.001), as did plasma triglycerides (from 151 ± 77 to 134 ± 72 mg/dL, p = 0.022). Basal proteinuria was 1.63 ± 1.34 g/day; it was significantly (p < 0.001) reduced by 23% at the first month, 37% at three months, and 33% at the last visit. Conclusions. Lercanidipine at 20 mg dose, associated to renin-angiotensin axis-blocking drugs, showed a high antihypertensive and antiproteinuric effect. This antiproteinuric effect seems to be dose-dependent as compared with previous reports and proportionally higher than blood pressure reduction.
Background and Aims:
Anemia is a common complication of heart failure and
chronic kidney disease (CKD). Sacubitril-valsartan is a novel therapy for the
treatment of chronic heart failure with a reduced ejection fraction (HFrEF). We
have evaluated the short-term effects of sacubitril-valsartan on the anemia of
CRS.
Methods:
The study group comprised 39 patients with HFrEF, who were
followed-up for three months. The study is a retrospective analysis of clinical
data. Data of 3 months’ visit and baseline visit were recorded including:
plasmatic creatinine, glomerular filtration rate, cystatin C, kaliemia,
haemoglobin, pro-BNP and albuminuria.
Results:
In all, 34 patients ended the follow-up. Mean sacubitril-valsartan dosage
at baseline was 101±62 mg/day and 126±59 mg/day at end. Mean hemoglobin
increased from 12.2±1.1 g/dl at baseline to 12.9±1.0 g/dl (p = 0.001,). Prevalence of
anemia was 64.7% (95%CI,47.9-78.5%) at baseline and 38.4 (95%CI,23.9-55.0%)
after the follow-up (p = 0.016). Serum cystatin C levels decreased from 2.71±1.0
to 2.48±1.0 mg/l (p = 0.028). Serum K levels remained unchanged (baseline
4.94±0.60, three months visit 4.94±0.61 mmol/l, p = 0.998).
Conclusions:
Sacubitril-valsartan improves anemia in CRS patients. An
improvement of serum cystatin levels was observed. Few untoward effects were
detected. These findings should be confirmed in wider clinical trials.
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