Long-Term Renoprotective Effects of Standard Versus High Doses of Telmisartan in Hypertensive Nondiabetic Nephropathies

Aranda, Pedro J.; Segura, Julián; Ruilope, Luís M.; Aranda, Francisco J.; Frutos, M.Á.; López, Verónica; Novales, E. Lopez de

doi:10.1053/j.ajkd.2005.08.034

Cited by 65 publications

(43 citation statements)

References 30 publications

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“…This high dose ARB data are similar to those of high dose Irbesartan (Rossing et al 2005), high dose Valsartan (Hollenberg et al 2007) and high dose Telmisartan (Aranda et al 2005). High dose ARBs help to further enhance reduction of proteinuria and stabilize as well as improve declining GFR in patients with CKD.…”

Section: Discussionsupporting

confidence: 67%

High dose Losartan and ACE gene polymorphism in IgA nephritis

Woo

Chan

Choong

et al. 2008

HUGO J

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Background/aims Several studies have reported varying results of the influence of ACE gene on ACEI/ ARB therapy. The efficacy of high dose ARB and its influence on ACE gene have not been explored. This is a 6 year randomised trial in IgA nephritis comparing high dose ARB (Losartan 200 mg/day) with normal dose ARB (Losartan 100 mg/day), normal dose ACEI (20 mg/day) and low dose ACEI (10 mg/day). Results Patients on high dose ARB had significantly lower proteinuria, 1.0 ± 0.8 gm/day compared to 1.7 ± 1.0 g/day in the other groups (P = 0.0005). The loss in eGFR was 0.7 ml min -1 year -1 for high dose ARB compared to 3.2-3.5 ml min -1 year -1 for the other three groups (P = 0.0005). There were more patients on high dose ARB with improvement in eGFR compared to other three groups (P \ 0.001). Comparing patients with the three ACE genotypes DD, ID and II, all three groups responded well to therapy with decrease in proteinuria (P \ 0.002). Only those on low dose ACEI (10 mg/day) with the I allele had increased in ESRF (P = 0.037). Conclusion High dose ARB is more efficacious in reducing proteinuria and preserving renal function when compared with normal dose ARB and ACEI, and also obviates the genomic influence of ACE gene polymorphism on renal survival.

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Section: Discussionsupporting

confidence: 67%

High dose Losartan and ACE gene polymorphism in IgA nephritis

Woo

Chan

Choong

et al. 2008

HUGO J

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“…For instance, Temlisartan 80 mg when used twice vs. once daily had significantly greater decline in proteinuria and progression of kidney disease, despite similar BP reduction. Additionally, combination therapy with ACEI and A2RBs has shown significant beneficial effect on proteinuria and kidney disease progression, more so when used in maximal or submaximal doses than maximum dose of either drug alone (23). This meta-analysis comparing combination therapy at submaximal doses to either agent alone at maximal doses confirmed these findings with greater reduction in proteinuria.…”

Section: Renal Trialssupporting

confidence: 76%

Recent Trials in Hypertension

Abouchacra¹,

Dastoor²

2012

Chronic Kidney Disease and Renal Transplantation

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“…Animal studies have demonstrated that maximal renal benefit from ACEi or ARB requires higher dosages than those needed to normalize BP (10,11). Small clinical studies have shown that titrating ACEi or ARB to higher dosages is effective at reducing proteinuria (12)(13)(14)(15), although there have been conflicting reports (16,17). Taken together, these data suggest that the recommended dosages of ACEi or ARB in current practice, which are based on their BP-lowering effect, might be inadequate to halt satisfactorily renal progression.…”

mentioning

confidence: 73%

Renoprotection of Optimal Antiproteinuric Doses (ROAD) Study

Hou

Xie²,

Zhang³

et al. 2007

Journal of the American Society of Nephrology

220

169

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The Renoprotection of Optimal Antiproteinuric Doses (ROAD) study was performed to determine whether titration of benazepril or losartan to optimal antiproteinuric doses would safely improve the renal outcome in chronic renal insufficiency. . Uptitration was performed to optimal antiproteinuric and tolerated dosages, and then these dosages were maintained. Median follow-up was 3.7 yr. The primary end point was time to the composite of a doubling of the serum creatinine, ESRD, or death. Secondary end points included changes in the level of proteinuria and the rate of progression of renal disease. Compared with the conventional dosages, optimal antiproteinuric dosages of benazepril and losartan that were achieved through uptitration were associated with a 51 and 53% reduction in the risk for the primary end point (P ‫؍‬ 0.028 and 0.022, respectively). Optimal antiproteinuric dosages of benazepril and losartan, at comparable BP control, achieved a greater reduction in both proteinuria and the rate of decline in renal function compared with their conventional dosages. There was no significant difference for the overall incidence of major adverse events between groups that were given conventional and optimal dosages in both arms. It is concluded that uptitration of benazepril or losartan against proteinuria conferred further benefit on renal outcome in patients who did not have diabetes and had proteinuria and renal insufficiency.

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Long-Term Renoprotective Effects of Standard Versus High Doses of Telmisartan in Hypertensive Nondiabetic Nephropathies

Cited by 65 publications

References 30 publications

High dose Losartan and ACE gene polymorphism in IgA nephritis

High dose Losartan and ACE gene polymorphism in IgA nephritis

Recent Trials in Hypertension

Renoprotection of Optimal Antiproteinuric Doses (ROAD) Study

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