Interim evidence of the renoprotective effect of the angiotensin II receptor antagonist losartan versus the calcium channel blocker amlodipine in patients with chronic kidney disease and hypertension: a report of the Japanese Losartan Therapy Intended for Global Renal Protection in Hypertensive Patients (JLIGHT) Study

Iino, Yuichi; Hayashi, Matsuhiko; Kawamura, Tetsuya; Shiigai, Tatsuo; Tomino, Yasuhiko; Yamada, Katsushi; Kitajima, T; Ideura, Terukuni; Kôyama, Akio; Sugisaki, Tetsuzo; Suzuki, Hiromichi; Umemura, Satoshi; Kawaguchi, Yoshindo; Uchida, Shunya; Kuwahara, Michio; Yamazaki, Tsutomu

doi:10.1007/s10157-003-0241-3

Cited by 22 publications

(5 citation statements)

References 25 publications

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“…Forty-seven patients in the losartan group and 40 patients in the amlodi-pine group completed the 12-month study for measurement of urinary protein endpoint. The dietary compliance assessment of 24-h urinary urea nitrogen plus proteins and sodium showed that, there was no significant difference in total protein and NaCl intake between the two drug treatment groups at baseline and no change from baseline to month 3, as reported previously (9). At month 12, again, there was no change from baseline and therefore no difference between the losartan group and the amlodipine group in protein intake or NaCl intake (protein [g/day]: losartan, 50.7 19.7; amlodipine, 53.5 17.0; NaCl [g/day]: losartan, 8.0 3.8; amlodipine, 9.6 3.5).…”

Section: Resultssupporting

confidence: 78%

“…Fifty-seven affiliated clinics in Japan contributed to this study. The overall design of the study has been described previously in an interim report presented at 3 months (9). Males and female outpatients, aged 20-74 years, who had CKD and hypertension and who met the following criteria during the 8-week pretreatment screening period were eligible for the study: 1) CKD: serum creatinine (Scr) levels of 1.5 ≤ Scr 3.0 mg/dl in males of body weight (BW) ≥ 60 kg, and of 1.3 ≤ Scr 3.0 mg/dl in females, or males of BW 60 kg.…”

Section: Methodsmentioning

confidence: 99%

“…For this reason, we have performed a 12-month study comparing the effects of the angiotensin II receptor antagonist losartan and the calcium channel blocker amlodipine. A portion of the results were previously disclosed as an interim report at 3 months (9) with the full analysis set (FAS) (10). We here report our final results based on the final selection of patients by the Coordinating Committee.…”

Section: Introductionmentioning

confidence: 99%

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Renoprotective Effect of Losartan in Comparison to Amlodipine in Patients with Chronic Kidney Disease and Hypertension-a Report of the Japanese Losartan Therapy Intended for the Global Renal Protection Hypertensive Patients (JLIGHT) Study

et al. 2004

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A 12-month, multicenter (57 clinical institutions), randomized, open-labeled trial was undertaken to compare the efficacy of the angiotensin II receptor antagonist losartan and the calcium channel blocker amlodipine in patients with proteinuric chronic kidney disease (CKD) and hypertension. A total of 117 patients (79, chronic glomerulonephritis; 14, diabetic nephropathy; 24, other CKD) were randomly allocated into two treatment groups. Losartan and amlodipine exerted the same efficacy for blood pressure (BP) control; however, losartan significantly reduced the 24-h urinary protein excretion at months 3, 6, and 12, with the reduction of 20.7%, 35.2%, 35.8%, whereas amlodipine did not change the amount of proteinuria over the 12-month study period. When patients were stratified into groups according to the level of BP control at 3 months, the reduction in urinary protein excretion by losartan was evident in the group for which a BP of <140/90 mmHg was achieved, as well as in the group for which the goal BP (<130/85 mmHg) for treatment of CKD was not achieved. When patients were stratified according to baseline urinary protein excretion, those with > or = 2 g/day showed a reduction in proteinuria by losartan of 23.3%, 39.4%, and 47.9% at months 3, 6, and 12, and those with <2 g/day showed a reduction of 18.5% and 31.2% at months 3 and 6, respectively. No fatal adverse events were experienced in either drug group. We conclude that losartan reduced proteinuria in patients with CKD and hypertension. This positive effect may contribute to the renal protective benefit of losartan, and is beyond the magnitude of BP control.

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Section: Resultssupporting

confidence: 78%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Renoprotective Effect of Losartan in Comparison to Amlodipine in Patients with Chronic Kidney Disease and Hypertension-a Report of the Japanese Losartan Therapy Intended for the Global Renal Protection Hypertensive Patients (JLIGHT) Study

et al. 2004

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“…29 In a larger trial of hypertensive patients, losartan significantly decreased proteinuria more than amlodipine in patients with higher and lower baseline levels of proteinuria. 30 An additional example is a reduction of proteinuria in normotensive patients with focal segmental glomerulosclerosis. 31…”

Section: Losartan and Proteinuriamentioning

confidence: 99%

Fifteen years of losartan: what have we learned about losartan that can benefit chronic kidney disease patients?

Ripley

Hirsch²

2010

IJNRD

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Losartan, the first AT1 receptor blocker (ARB), was FDA approved 15 years ago. During those years, researchers and clinicians have developed a growing base of knowledge on the benefits of losartan, particularly for hypertension and renal disease. These benefits include decreasing proteinuria, slowing the progression of diabetic nephropathy, controlling hypertension, and decreasing stroke risk in patients with left ventricular hypertrophy. Although many of the benefits of losartan represent a class effect for ARBs, losartan has pharmacokinetic and pharmacodynamic characteristics and effects that are unique and are not a class effect. For example, a shorter duration of action is seen with this first ARB compared with other more recently approved ARBs. Losartan also has a uricosuric effect not seen in other ARBs and attenuates platelet aggregation, which is not seen or is seen to a lesser extent with the other ARBs. This review presents the physiological effects of losartan on the kidney and discusses relevant clinical outcomes.

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“…Among these, DHP derivatives and Ca channel blockers have been reported to have strong hypotensive actions and have been indicated for many patients in Japan [ 2 ]. In addition, ARBs have organ-protective effects [ 24 , 25 ], and the low frequency of adverse effects and high tolerability [ 26 ] associated with them are thought to contribute to their widespread use. However, the use of antihypertensive drugs varies across countries [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship between antihypertensive drug use and number of people with high blood pressure in FY 2018: a descriptive epidemiological study based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan open data

Mizuno,

Inose,

Yoshimura

et al. 2023

J Pharm Health Care Sci

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Background In most countries barring Japan, antihypertensive drug use has been reported using the defined daily doses/1000 inhabitants/day (DID). Although DID has been shown to allow for the assessment of the number of patients treated with a particular drug, the relationship between DID and the number of patients with hypertension has not been clarified. This study aimed to clarify the relationship between antihypertensive drug use and the number of people with high blood pressure based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) open data. Methods DID was calculated by extracting the use of oral antihypertensive drugs from outpatient prescriptions in the NDB Open Data in FY 2018. The number of people with high blood pressure was calculated using the number of enrollees in each sex–age group for systolic and diastolic blood pressure in the 40–74 years age group. The correlation between the DID of antihypertensive drugs and the number of people with high blood pressure by sex and age class was evaluated using Spearman’s rank correlation coefficient. Results The use of antihypertensive drugs increased with age in both men and women. Furthermore, in both sexes, dihydropyridine derivatives, calcium antagonists, and angiotensin II receptor blockers were the main drugs used from the age of 20 years onward. In addition, a very strong positive correlation was found between the number of people with high systolic blood pressure and DID in both sexes (men: r = 1, P < 0.05; women: r = 1, P < 0.05). In contrast, there was no significant correlation between the number of people with high diastolic blood pressure and DID in both sexes (men: r = − 0.214, P > 0.05; women: r = 0.393, P > 0.05). Conclusions To our knowledge, this study is the first to investigate the use of oral antihypertensive drugs in outpatient settings in Japan. In addition, the DID of antihypertensive drugs can be used as an alternative indicator of the number of people with high systolic blood pressure.

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Abstract: Losartan appeared to be efficacious for renoprotection in patients with proteinuric CKD and hypertension, with the mechanism being independent of its antihypertensive action.

Cited by 22 publications

References 25 publications

Renoprotective Effect of Losartan in Comparison to Amlodipine in Patients with Chronic Kidney Disease and Hypertension-a Report of the Japanese Losartan Therapy Intended for the Global Renal Protection Hypertensive Patients (JLIGHT) Study

Renoprotective Effect of Losartan in Comparison to Amlodipine in Patients with Chronic Kidney Disease and Hypertension-a Report of the Japanese Losartan Therapy Intended for the Global Renal Protection Hypertensive Patients (JLIGHT) Study

Fifteen years of losartan: what have we learned about losartan that can benefit chronic kidney disease patients?

Relationship between antihypertensive drug use and number of people with high blood pressure in FY 2018: a descriptive epidemiological study based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan open data

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