Angiotensin II receptor blocker and long-acting calcium channel blocker combination therapy decreases urinary albumin excretion while maintaining glomerular filtration rate

Abstract

, the NICE-Combi Study GroupMicroalbuminuria is a recognized risk factor and predictor for cardiovascular events in patients with hypertension. We analyzed changes in hypotensive effect, urinary albumin excretion (UAE) and estimated glomerular filtration rate (eGFR) in subjects with hypertension and microalbuminuria as a subanalysis of the results of the Nifedipine and Candesartan Combination (NICE-Combi) Study. A total of 86 subjects with essential hypertension with microalbuminuria (UAE o300 mg g À1 creatinine) were randomly assigned in a double-blind manner to a combination therapy group (standard-dose candesartan at 8 mg per day plus controlledrelease (CR) nifedipine 20 mg per day) (n¼42) or an up-titrated monotherapy group (candesartan 12 mg per day) (n¼44) for 8 weeks of continuous treatment after initially receiving standard-dose candesartan (8 mg per day) monotherapy for 8 weeks (initial treatment). After 8weeks, blood pressure (BP) was significantly reduced in both groups compared with at the end of initial treatment. UAE also showed a significant decrease in the combination therapy group, while there was no significant change of eGFR in either group. A significant positive correlation was seen between BP reduction and UAE after 8 weeks of double-blind treatment in both groups, whereas no significant association was found between DUAE and DeGFR in either group. These findings show that combination therapy with standard-dose candesartan and nifedipine CR is more effective than up-titrated candesartan monotherapy for reducing BP and improving UAE while maintaining eGFR, and strongly suggest that the combination of an angiotensin II receptor blocker and long-acting calcium channel blocker is beneficial in patients with hypertension and microalbuminuria.

Amlodipine Seems To Be Superior to Valsartan in Decreasing Microalbuminuria in Newly Diagnosed Hypertensive Patients: A Novel Effect To Be Explained with Hyperfiltration?

“…Treatment with renin-angiotensin aldosterone system (RAAS) inhibitors and calcium channel blockers has a well-known anti-proteinuric effect besides lowering BP. [8][9][10][11] In this study, we aimed to compare the anti-albuminuric effects of an angiotensin II receptor antagonist, valsartan, with a calcium channel blocker, amlodipine, in newly diagnosed hypertensive patients.…”

Management of Home Blood Pressure by Amlodipine Combined With Angiotensin II Receptor Blocker in Type 2 Diabetes

“…21 Our study did not obtain the superiority of combination regimen to increased ARB regimen in reduction of urinary albumin. As one of this reason, it might be considered that urinary albumin level was low; half of patients were categorized into normoalbuminuria in contrast to the NICE-Combi Study.…”

Efficacies of Controlling Morning Blood Pressure and Protecting the Kidneys by Treatment With Valsartan and Nifedipine CR or Valsartan and Amlodipine (MONICA Study)

“…When nifedipine CR was administered at night, nocturnal BP was significantly decreased [17], and U-Alb excretion may also be decreased. Second, different kinds of CCBs prevent albuminuria to different degrees [11, 12]. In fact, some reports have indicated that nifedipine CR decreased albuminuria.…”

“…Nifedipine CR and cilnidipine, but not efonidipine and amlodipine, significantly reduced albuminuria [11]. Combination therapy with standard-dose candesartan and nifedipine CR is more effective than up-titrated candesartan monotherapy for reducing BP and improving U-Alb while maintaining eGFR [12]. Interestingly, nifedipine prevented pressure-induced afferent arteriolar vasoconstriction in an isolated perfused hydronephrotic kidney in rat [25].…”