Comparison of the renal effects of angiotensin converting enzyme inhibitor and calcium antagonist in hypertensive Type 2 (non-insulin-dependent) diabetic patients with microalbuminuria: a randomised controlled trial

Baba, Tsuneharu; Murabayashi, S; Takebe, Kazuo

doi:10.1007/bf00265402

Cited by 104 publications

(26 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…279 In a number of recent studies, these investigators have sought to compare calcium antagonists with ACE inhibitor therapy in conferring beneficial effects on glomerular permeability to proteins and, in a few instances, in attenuating progression in patients with established diabetic glomerular disease. 273 - 277 The reports have been widely divergent. Although calcium antagonist therapy has been found to diminish proteinuria significantly in some studies, 272 -276 others have shown either no effect at all or an actual worsening of the proteinuria.…”

Section: Pharmacotherapymentioning

confidence: 99%

Diabetes mellitus and hypertension.

Epstein¹,

Sowers²

1992

Hypertension

531

271

View full text Add to dashboard Cite

Diabetes mellitus and hypertension are common diseases that coexist at a greater frequency than chance alone would predict Hypertension in the diabetic individual markedly increases the risk and accelerates the course of cardiac disease, peripheral vascular disease, stroke, retinopathy, and nephropathy. Our understanding of the factors that markedly increase the frequency of hypertension in the diabetic individual remains incomplete. Diabetic nephropathy is an important factor involved in the development of hypertension in diabetics, particularly type I patients. However, the etiology of hypertension in the majority of diabetic patients cannot be explained by underlying renal disease and remains "essential" in nature. The hallmark of hypertension in type I and type II diabetics appears to be increased peripheral vascular resistance. Increased exchangeable sodium may also play a role in the pathogenesis of blood pressure in diabetics. There is increasing evidence that insulin resistance/ hyperinsulinemia may play a key role in the pathogenesis of hypertension in both subtle and overt abnormalities of carbohydrate metabolism. Population studies suggest that elevated insulin levels, which often occurs in type II diabetes mellitus, is an independent risk factor for cardiovascular disease. Other cardiovascular risk factors in diabetic individuals include abnormalities of lipid metabolism, platelet function, and clotting factors. The goal of antihypertensive therapy in the patient with coexistent diabetes is to reduce the inordinate cardiovascular risk as well as lowering blood pressure. (Hypertension 1992;19:403-418) KEY WORDS • diabetes mellitus • diabetic nephropathy • essential hypertension • kidney failure D iabetes mellitus and hypertension are two of the most common diseases in Westernized, industrialized civilizations, and the frequency of both diseases increases with increasing age. 1 -9 An estimated 2.5 to 3 million Americans have both diabetes and hypertension.10 Although diabetes mellitus is associated with a considerably increased cardiovascular risk, 11 -18 the presence of hypertension in the diabetic individual markedly increases morbidity and mortality 5. 10, 19 p r o m d a ta drawn from death certificates, hypertension has been implicated in 44% of deaths coded to diabetes, and diabetes is involved in 10% of deaths coded to hypertension. 20 It has been estimated that 35-75% of diabetic complications can be attributed to hypertension.10 In contrast, the absence of hypertension is the usual finding in long-term survivors of diabetes. 21-22 Thus, the coexistence of these two diseases likely contributes substantially to overall mortality in industrialized societies. Despite the critical importance of the coexistence of these two diseases, much information regarding their interaction remains unclear and controversial. Nevertheless, much information of theoretical and practical relevance is available, and there is considerable ongoing research exploring the relation between carbohydrate intolerance and h...

show abstract

Section: Pharmacotherapymentioning

confidence: 99%

Diabetes mellitus and hypertension.

Epstein¹,

Sowers²

1992

Hypertension

531

271

View full text Add to dashboard Cite

show abstract

“…Calcium antagonists have been demonstrated to inhibit vasoconstrictive, hypertrophic, and hyperplastic actions of AgII via blocking the calcium-dependent mechanism. [21] It is also reported that prevention and treatment of calcium antagonism in diabetic nephropathy is specific and goes beyond the effects of the hypotensive action only. [22] Even though it is reported that both hypotensive and nonhemodynamic action are responsible for the reduced renal damage by calcium channel blockers, the exact renoprotective mechanism of calcium blockade is very complex.…”

Section: Introductionmentioning

confidence: 99%

Diltiazem Attenuates Oxidative Stress in Diabetic Rats

Anjaneyulu

Chopra

2005

Renal Failure

View full text Add to dashboard Cite

Diabetic nephropathy is the main cause of end stage renal damage. Oxidative stress is involved in the etiology of diabetic nephropathy and intracellular calcium is reported to play a considerable role in the development of renal damage in the diabetic kidney. Calcium antagonism can slow the progression of renal impairment in diabetes. The present study was thus designed to examine the effect of a nondihydropyridine calcium channel blocker, diltiazem, on renal function, oxidative stress, and nitric oxide (NO) release in streptozotocin (STZ)-induced diabetic rats. Diabetes was induced by a single intraperitoneal injection of STZ (65 mg/kg) in rats. After 4 weeks of STZ injection, the rats were divided in to four groups: control rats, diabetic rats treated with saline, and two groups of diabetic rats treated with diltiazem (5 and 10 mg/kg, i.p, respectively) for 8 weeks starting from 4 weeks after STZ injection. Renal function was assessed by creatinine, blood urea nitrogen, creatinine clearance, and urea clearance. Oxidative stress was measured by renal malondialdehyde (MDA), reduced glutathione (GSH), superoxide dismutase (SOD), and catalase. We also measured renal nitrite levels. At the end of the 8 weeks, diabetic rats exhibited renal dysfunction as evidenced by reduced creatinine and urea clearance along with enhanced albumin excretion rate as compared with control rats. Biochemical analysis of kidneys revealed a marked increase in oxidative stress demonstrated by increased lipid peroxidation and decreased activities of key antioxidant enzymes, GSH, SOD, and catalase in diabetic rats. Release of NO also significantly higher in diabetic rats than controls. Chronic treatment with diltiazem in diabetic rats significantly attenuated both renal dysfunction and oxidative stress along with increased NO levels as compared with untreated diabetic rats. The kidneys of diabetic rats showed morphological changes such as hyaline casts, glomerular thickening, and moderate interstitial fibrosis and arteriolopathy, whereas diltiazem administration markedly prevented diabetic-induced renal morphological alterations. The present study suggests that oxidative stress/nitrosative stress is increased in the diabetic kidney and calcium channel blockage can prevent these changes. The results also suggest that in STZinduced diabetic rats, the protective action of diltiazem might be mediated, at least in part, by its effect on tissue oxidant/ antioxidant status.

show abstract

“…On the other hand, most studies [23][24][25][26] report a significant reduction in MAP, no change in GFR, and a significant decline in UAE with both ACEI and CaA (nifedipine included).…”

Section: Acei Versus Caa In Diabetic Nephropathy (Dn)mentioning

confidence: 99%

Protecting the Residual Renal Function: How Do ACE Inhibitors and Calcium Antagonists Compare?

Maschio¹

1994

Nephron

View full text Add to dashboard Cite

Comparison of the renal effects of angiotensin converting enzyme inhibitor and calcium antagonist in hypertensive Type 2 (non-insulin-dependent) diabetic patients with microalbuminuria: a randomised controlled trial

Cited by 104 publications

References 37 publications

Diabetes mellitus and hypertension.

Diabetes mellitus and hypertension.

Diltiazem Attenuates Oxidative Stress in Diabetic Rats

Protecting the Residual Renal Function: How Do ACE Inhibitors and Calcium Antagonists Compare?

Contact Info

Product

Resources

About