Contrasting effects of captopril and nifedipine in normotensive patients with incipient diabetic nephropathy

Mimran, A; Insua, A.; Ribstein, Jean; Monnier, L.; Bringer, J.; Mirouze, J

doi:10.1097/00004872-198811000-00011

Cited by 88 publications

(22 citation statements)

References 12 publications

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“…36 Which of these factors predominates remains to be established. Unlike previous studies which found no significant effect of dihydropyridine CCBs on UAE, 18,21,22,37,38 in our study we observed a reduction of UAE in the nitrendipine-treated patients, but such an antiproteinuric effect became statistically significant only after 1 year of treatment and was less pronounced as compared to the ramipril induced UAE reduction. This finding suggests two considerations: (a) first, the reduction in UAE from nitrendipine could be mainly attributed to the decrease in systemic BP rather than to other intrinsic effects of the drug, which is supported by the correlation between the UAE and the SBP changes that we found in the nitrendipine but not in the ramipril-treated patients.…”

Section: Discussioncontrasting

confidence: 99%

“…[17][18][19][20] Conversely, most studies with the dihydropyridine CCB nifedipine demonstrated no effect or increases in UAE. [18][19][20][21]22 However, caution is needed in interpreting the results of these studies, which have been relatively short in duration. Indeed, some recent comparisons of the long-term effect of ACE-I and dihydropyridine CCB in diabetic patients with incipient nephropathy have shown that both drugs decreased albuminuria with no difference in their effects.…”

Section: Introductionmentioning

confidence: 99%

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Long-term effects of ramipril and nitrendipine on albuminuria in hypertensive patients with type II diabetes and impaired renal function

et al. 1999

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The aim of this study was to compare the effects of ramipril and nitrendipine chronic treatment on urinary albumin excretion (UAE) in hypertensive patients with type II non-insulin-dependent diabetes mellitus (NIDDM) and impaired renal function. A 2-year, prospective, randomised study was conducted on 51 men with a diastolic blood pressure (DBP) у95 and р105 mm Hg, stable NIDDM, serum creatinine between 1.6 and 3.0 mg/dl and persistent UAE Ͼ300 and Ͻ2000 mg/24 h. After a 3-month preliminary observation period, during which patients began a low-protein, low-sodium diet, and a subsequent 4-week run-in period on placebo, patients were randomly treated with ramipril 5 mg or nitrendipine 20 mg for 2 years. Both drugs similarly reduced BP without affecting glucose homeostasis. In the ramipril group

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term effects of ramipril and nitrendipine on albuminuria in hypertensive patients with type II diabetes and impaired renal function

et al. 1999

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“…6 - 8 Recently, a study of a small group of normotensive diabetics demonstrated an advantage of captopril over nifedipine treatment on urinary excretion of albumin. 11 In contrast, a recent multicenter study of microalbuminuria in patients with type I and type II diabetes mellitus showed that both perindopril and nifedipine, which reduced blood pressure to similar degrees, were equivalent in efficacy in reducing microalbuminuria. 36 The mechanism of chronic action of ACE inhibitors is unclear.…”

Section: Discussionmentioning

confidence: 94%

Salt blocks the renal benefits of ramipril in diabetic hypertensive rats.

1991

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To establish if the benefit of angiotensin converting enzyme inhibitor therapy in retarding progressive diabetic renal injury is due to a specific intrarenal effect or the systemic hypotensive effect, we studied the effect of long-term ramipril treatment on blood pressure, glomerular filtration rate, and urinary protein excretion in streptozotocin-diabetic spontaneously hypertensive rats. The hypotensive effect of ramipril was prevented by a high salt diet, which did not alter the degree of renal angiotensin converting enzyme inhibition. Three weeks after uninephrectomy and induction of diabetes, rats were allocated to three groups. Groups 1 and 2 were given 1% NaCl, whereas group 3 was given water as drinking solution. One week later, groups 2 and 3 received 0.4 mg/kg/day ramipril in their drinking solution, which was continued over a 2-month period. Ramipril produced a blood pressure fall only in water-drinking rats (group 3) despite a similar reduction in plasma and renal angiotensin converting enzyme activity in groups 2 and 3. Salt-loaded rats had a progressive increase in urinary protein excretion over the duration of study. Ramipril treatment prevented an increase in protein excretion only in animals given water and with a reduced systolic blood pressure. Glomerular nitration rate was similar in all three groups. Ramipril treatment improved animal survival independently of a reduction in blood pressure or an effect on proteinuria. Although it is possible that angiotensin converting enzyme inhibitors have specific intrarenal effects reducing progression of diabetic proteinuria, concomitant control of systemic blood pressure appears to be necessary to demonstrate a benefit. (Hypertension 1991;17:497-503) U ncontrolled systemic hypertension is a wellknown cause of progressive renal injury in both humans and experimental animals. 1Hypertension is commonly associated with diabetic renal disease,'-3 and it has been shown to accelerate the rate of development of diabetic nephropathy both in humans 4 and in streptozotocin-diabetic rats. 13 or in other renal disorders. 1415 However, it is difficult to determine from these studies if the beneficial effect of ACE Received February 9, 1990; accepted in revised form November 29, 1990. inhibitors was due to a specific intrarenal effect of ACE inhibition or due to their systemic hypotensive effect.To evaluate this question further, we examined the effect of long-term administration of the ACE inhibitor ramipril on blood pressure, glomerular filtration rate, and proteinuria in streptozotocin diabetic uninephrectomized spontaneously hypertensive rats (SHR). To prevent the hypotensive effect of ACE inhibition, the rats were maintained on a high salt diet, which is known to oppose the blood pressurelowering action of ACE inhibitors. -17 Methods Study Protocol

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“…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

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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...

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Contrasting effects of captopril and nifedipine in normotensive patients with incipient diabetic nephropathy

Cited by 88 publications

References 12 publications

Long-term effects of ramipril and nitrendipine on albuminuria in hypertensive patients with type II diabetes and impaired renal function

Long-term effects of ramipril and nitrendipine on albuminuria in hypertensive patients with type II diabetes and impaired renal function

Salt blocks the renal benefits of ramipril in diabetic hypertensive rats.

Diabetes mellitus and hypertension.

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