Kidney-protective effects of azelnidipine versus a diuretic in combination with olmesartan in hypertensive patients with diabetes and albuminuria: a randomized study

Abstract

Azelnidipine is equally effective as a thiazide diuretic in reducing urinary albumin when used in combination with olmesartan.

Comparison of the Antialbuminuric Effects of Benidipine and Hydrochlorothiazide in Renin-Angiotensin System (RAS) Inhibitor-Treated Hypertensive Patients with Albuminuria: the COSMO-CKD (COmbination Strategy on Renal Function of Benidipine or Diuretics TreatMent with RAS inhibitOrs in a Chronic Kidney Disease Hypertensive Population) Study

“…Another recent study 17 demonstrated the non-inferiority of the antialbuminuric effect of azelnidipine, another so-called “renoprotective” CCB 18, compared with the thiazide diuretic, trichloromethiazide. Because several different mechanisms have been attributed to the “renoprotective” CCBs (e.g., T-type calcium channel blockade (benidipine), N-type calcium channel blockade (benidipine and cilnidipine), and sympatholytic effects (azelnidipine)), the extent of antialbuminuric action might be different among these agents.…”

Renoprotective effects of renin–angiotensin system inhibitor combined with calcium channel blocker or diuretic in hypertensive patients

“…Among them, 8 RCTs recruited Asian subjects only, [ 13 – 15 , 18 , 20 , 21 , 23 , 24 ] while the other 6 RCTs were conducted in either mixed-race or unmentioned-race populations. Six RCTs compared the 2 combined treatments in 1001 patients with diabetes mellitus, [ 13 , 14 , 16 , 17 , 22 , 25 ] and 3 RCTs compared treatments in 1079 CKD patients. [ 19 , 23 , 24 ] Regarding the sample size, ACCOMPLISH (11,506 patients) and COLM (5141 patients) were the 2 largest RCTs.…”

“…Five studies obtained Jadad scores lower than 3, [ 15 , 16 , 18 , 20 , 24 ] indicating low quality. The Cochrane Collaboration assessment suggested that 8 studies were at a high risk of bias [ 12 , 14 – 16 , 18 , 20 , 23 , 24 ] (Table 1 ). The main reason for the high risk was the lack of detailed descriptions of concealing, randomization, or allocation.…”

“…Seven trials reported the change in eGFR [ 13 – 15 , 19 , 20 , 23 , 25 ] and 2 trials reported the change in CrCl. [ 16 , 17 ] Four showed that ACEI/ARB plus CCB was the better treatment choice than ACEI/ARB plus diuretic, [ 13 , 14 , 19 , 25 ] whereas the remaining 5 studies showed no difference between the 2 treatment strategies. In this meta-analysis, the endpoints of eGFR and CrCl were synthesized in 1 forest plot as both were considered as indicators of kidney function, [ 27 , 35 , 36 ] representing the capability for material filtration of kidneys.…”