Effects of Ramipril and Telmisartan on Plasma Concentrations of Low Molecular Weight and Protein Thiols and Carotid Intima Media Thickness in Patients with Chronic Kidney Disease

Abstract

Hypertension, a common feature in chronic kidney disease (CKD), is an independent risk factor for CKD progression and cardiovascular disease. Although inhibitors of the renin-angiotensin system (RAS) exert salutary effects on blood pressure control and proteinuria in CKD patients, their activity towards traditional and novel oxidative markers is largely unknown. We studied the effects of 6-month treatment with telmisartan versus a combination of telmisartan and ramipril on plasma concentrations of low molecular mass (LMW, including homocysteine and cysteine) and protein thiols (PSH) plasma concentration and their relationships with carotid intima media thickness (IMT), in 24 hypertensive CKD patients (age 60 ± 12 years, 8 females and 16 males). Pretreatment PSH concentrations were independently associated with IMT (r = −0.42, p = 0.039). Neither treatment affected plasma LMW thiols, in both reduced and total form. By contrast, both treatments increased PSH plasma concentrations and reduced IMT, although significant differences were only observed in the combined treatment group. Our results suggest that the beneficial effects of combined RAS inhibitor treatment on IMT in hypertensive CKD patients may be mediated by a reduction of oxidative stress markers, particularly PSH.

Efficacy and safety of dual vs single renin–angiotensin–aldosterone system blockade in chronic kidney disease

“…[ 17 ] Proteinuria is still present in some patients after treatment with ACEI or ARB. [ 18 , 19 ] Based on subgroup analyses, ACEI in combination with ARB was a superior dual therapy in reducing urine albumin excretion, urine protein excretion and BP compared with single therapy.…”

Effect of angiotensin receptor blockers on blood pressure and renal function in patients with concomitant hypertension and chronic kidney disease: a systematic review and meta-analysis

“…The characteristics of the 24 studies [22][23][24][25][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] included in the meta-analysis are shown in Table 1. These studies were published between 1998 and 2017, with sample sizes ranging from 9 to 1715 subjects.…”

“…Within individual studies, however, two [39,41] had high-risk in random sequence generation and one [39] in allocation concealment. In addition, in some studies, details of the methods for generating the random sequence [36,42,44,[47][48][49][50][51]53] and allocation concealment [36,41,42,44,[47][48][49][50]55] were not provided, and outcome data were incomplete [41,44] (Supplementary Figure S5).…”

Cardiovascular Risk Assessment Using Ultrasonographic Surrogate Markers of Atherosclerosis and Arterial Stiffness in Patients With Chronic Renal Impairment: A Narrative Review of the Evidence and a Critical View of Their Utility in Clinical Practice

“…Despite the lack of quality evidence that cIMT regression actually improves clinical outcomes, several RCTs studied the effect of interventions on cIMT regression in patients with CKD and ESRD (Table 2). 28,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Notably, magnesium administration improved cIMT compared with placebo in 2 small studies of approximately 50 HD patients over a period of 6 months. 30,36 Lowering the dialysate calcium concentration (1.25 mmol/L vs 1.5 mmol/L) was shown to improve cIMT and survival rate in patients on HD.…”