Effects of Nitrendipine and Cilazapril on Renal Hemodynamics and Albuminuria in Hypertensive Patients with Chronic Renal Failure

Kloke, H. J.; Wetzels, Jack F.M.; Hamersvelt, Henk W. van; Koene, R. A. P.; Kleinbloesem, C. H.; Huysmans, F. T. M.

doi:10.1097/00005344-199012000-00010

Cited by 20 publications

(7 citation statements)

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“…Furthermore, proteinuria is correlated with the progression of renal failure [12,13]. In our patients captopril clearly decreased protein excretion, which is in agreement with previous studies [14][15][16], but atenolol also reduced proteinuria to the same extent. Our data thus suggest that ACE inhibitors and /3-blockers have equal antiproteinuric effects.…”

Section: Discussionsupporting

confidence: 92%

Captopril and atenolol are equally effective in retarding progression of diabetic nephropathy

Elving¹,

Wetzels

Lier³

et al. 1994

Diabetologia

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SummaryThe progression of diabetic nephropathy can be positively influenced by maintaining a low blood pressure level. This has been shown in studies with conventional antihypertensive treatment as well as with ACE inhibitors. Whether the latter group of drugs is more effective remains to be proven and was the aim of our study. In a prospective randomized study we compared the effects of ACE inhibition and ]3-blockade on retarding progression of renal function in IDDM patients with an early stage of overt diabetic nephropathy. Twenty-nine patients were studied for 2 years, 15 were randomized for treatment with captopril and 14 for atenolol. Every 6 weeks blood pressure and urinary albumin and total protein excretion were measured. GFR was measured every 6 months as 51Cr-EDTA clearance. Baseline values for blood pressure, renal function and alb uminuria were identicalin the two groups. The effect of both drugs on blood pressure was not significantly different. In the captopril-treated patients MAP before and after 2 years was 110 + 3 (SEM) and 100 + 2 mm Hg, respectively and in the atenolol-treated patients 105 + 2 vs 101 + 2 mmHg. Both drugs reduced albuminuria and total proteinuria to the same extent. With captopril albuminuria decreased from 1549 (989-2399) to 851 (537-1380) rag/24 h and proteinuria from 2.5 (1.6-3.8) to 1.2 (0.8-1.8) g/24 h. With atenolol albuminuria decreased from 933 (603-1445) to 676 (43%1047)mg/ 24 h and proteinuria from 1.5 (1.0-2.4) to 0.9 (0.6-1.5) g/24 h. The rate of decline of GFR was similar with both treatments, on captopril -4.9 + 2.1 and on atenolol -3.7 + 1.6 ml. min-1. year-1. No major side effects with either drug were observed. We conclude that, in this 2-year study, captopril and atenolol are equally effective in retarding progression of diabetic nephropathy. [Diabetologia (1994) 37: 604-609]

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Section: Discussionsupporting

confidence: 92%

Captopril and atenolol are equally effective in retarding progression of diabetic nephropathy

Elving¹,

Wetzels

Lier³

et al. 1994

Diabetologia

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“…During chronic treatment cilazaprilat concentrations measured at 24 h were considerably lower in the high clearance than in the low clearance groups, in accordance with previously reported data [4,5,11]. Only in patients with a low creatinine clearance did the increase in drug dosage cause an increase in cilazaprilat concen trations at 24 h. However, no accumulation was seen in these groups.…”

Section: Ab-s Ab-i Cd-s Cd-isupporting

confidence: 91%

“…Comparable antiproteinuric effects have been reported in the literature [5,17]. Serum creatinine rose steadily only during the treatment in the low clearance groups.…”

Section: Ab-s Ab-i Cd-s Cd-isupporting

confidence: 75%

“…However, probably due to the high affinity of cilazaprilat for angiotensin converting enzyme the terminal half-life of this drug is as long as 40 to 50 h [1,2]. In patients with renal insufficiency only limited pharmacokinetic and pharmacodynamic data on chronic cilazaprilat administration are available [3][4][5]. Therefore, we investigated the pharmacokinetic properties of cilazapri lat in hypertensive patients with various degrees of renal insufficiency both after a single dose as well as during chronic treatment.…”

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confidence: 99%

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Pharmacokinetics and haemodynamic effects of the angiotensin converting enzyme inhibitor cilazapril in hypertensive patients with normal and impaired renal function

Kloke

Ambros

Hamersvelt

et al. 1996

Br J Clin Pharmacol

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“…[12][13][14][15] Instead, there is some controversy as to the intrarenal haemodynamic effects of second generation dihydropyridinic calcium antagonists, as their vasodilatory effect on the efferent arteriole may vary according to the drug used. [16][17][18][19][20][21][22][23][24] In particular, the results of some studies suggest that amlodipine (AML) does not significantly reduce postglomerular resistances, 20,[22][23][24] whereas others have shown that amlodipine, nitrendipine (NIT) and other second-generation dihydropyridinic calcium antagonists induce haemodynamic variations suggesting a mainly efferent vasodilatory effect. [16][17][18][19]21 Unfortunately, as the method is highly complex, it has only been possible to carry out studies of the intrarenal haemodynamic effects of antihypertensive drugs on relatively small patient samples, and the assumption that calcium antagonists in general have only limited efficacy in reducing glomerular hyperfiltration has remained strong.…”

Section: Introductionmentioning

confidence: 99%

Nitrendipine and amlodipine mimic the acute effects of enalapril on renal haemodynamics and reduce glomerular hyperfiltration in patients with chronic kidney disease

et al. 2003

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Antihypertensive drugs may have an important effect on glomerular haemodynamics. In chronic nephropathy patients, we compared the effect on glomerular haemodynamics of two second-generation dihydropyridinic agents, nitrendipine and amlodipine, with a first generation dihydropyridinic agent and an ACE-inhibitor, enalapril. In all, 32 patients (pts), divided into four groups, received the different drugs: ENA (enalapril, eight pts), NIF (nifedipine, eight pts), NIT (nitrendipine, eight pts) AML (amlodipine, eight pts). The study assessed the effect on glomerular haemodynamics of a single administration of the test drug in baseline conditions and in glomerular hyperfiltration experimentally induced by amino-acid infusion. The glomerular filtration rate (GFR, measured by inulin clearance), effective renal plasma flow (ERPF, measured by p-aminohippurate clearance), renal vascular resistances (RVR) and filtration fraction (FF) were assessed. Administration of AML and NIT test dose reduced FF, as did ENA, but not NIF, in both baseline (AML: P ¼ 0.005; NIT: P ¼ 0.02; ENA: P ¼ 0.007) and glomerular hyperfiltration conditions (AML: P ¼ 0.0003; NIT: P ¼ 0.03; ENA: P ¼ 0.00006). In baseline conditions, only ENA resulted in a significant drop in the GFR (P ¼ 0.008), while NIF, NIT and AML induced a significant increase (P ¼ 0.003, 0.03, 0.0001, respectively). However, in hyperfiltration conditions, NIT (0.08) and AML (0.00003) caused a decrease in the GFR, as did ENA (0.0003) but not NIF. In all the experimental conditions, a RVR reduction and an ERPF increase were observed. Single dose of NIT and AML were effective in attenuating the effect of amino-acid infusion on glomerular filtration, similar to ENA; this effect of NIT and AML on the glomerular filtration rate is not observed under basal conditions.

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Effects of Nitrendipine and Cilazapril on Renal Hemodynamics and Albuminuria in Hypertensive Patients with Chronic Renal Failure

Cited by 20 publications

References 0 publications

Captopril and atenolol are equally effective in retarding progression of diabetic nephropathy

Captopril and atenolol are equally effective in retarding progression of diabetic nephropathy

Pharmacokinetics and haemodynamic effects of the angiotensin converting enzyme inhibitor cilazapril in hypertensive patients with normal and impaired renal function

Nitrendipine and amlodipine mimic the acute effects of enalapril on renal haemodynamics and reduce glomerular hyperfiltration in patients with chronic kidney disease

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