Release From Glomerular Overload by the Addition of Low-dose Thiazide in Patients With Angiotensin Receptor Blocker-Resistant Hypertension

Hasegawa, Hajime; Tayama, Yosuke; Takayanagi, Kaori; Asakura, Juko; Nakamura, Tõru; Kawashima, Kenji; Shimizu, Taisuke; Iwashita, Takatsugu; Ogawa, Tomonari; Matsuda, Akihiko; Mitarai, Tetsuya

doi:10.1159/000355732

Cited by 4 publications

(2 citation statements)

References 31 publications

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“…The effect of losartan in the change of intrarenal RAS: with Wistar rats in high-salt diet, Losartan failed to reduce SBP but abolished the increase of proteinuria, renal cortex renin, angiotensinogen, angiotensin II and urinary angiotensinogen when compared with high salt group [31]. There are similar accounts of the renal protective effect: the losartan/thiazide combination therapy attenuated glomerular overload, indicating that this therapy may provide glomerular protection in patients with an elevated GFR without causing prolonged damage to renal function [32]. With low-salt diet administering 50 mg Losartan inhibition of AT1 receptors could lead to activation of AT2 receptors, which maintain skin hyperaemia despite the increased level of vasoconstrictor thromboxane A2 [33].…”

Section: Introductionmentioning

confidence: 92%

Treatment of Hypertension: Favourable Effect of the Twice-Daily Compared to the Once-Daily (Evening) Administration of Perindopril and Losartan

Ipoly¹,

Csajági

Major

et al. 2015

Kidney Blood Press Res

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Background/Aims: Little is known about the effect of twice daily administration of same dose of ACE inhibitor and ARB on the diurnal/nocturnal blood pressure (BP) ratio. We aimed to assess the effect of two widely used long-acting drugs: perindopril and losartan in the treatment of hypertension comparing the once-daily (evening) vs. twice-daily (morning and evening) administration with the same daily doses. Methods: Untreated primary hypertensive patients without complaints (a total of 164: 65 men, 99 women, 55.7±13.7 years of age, 41-41 patients per treated groups) were selected with non-dipper phenomenon, estimated by diurnal index (DI) <10%. The effect of evening (8 mg perindopril or 100 mg losartan) vs morning and evening (4-4 mg perindopril or 50-50 mg losartan) administration was determined on a 14-day treatment by ABPM. Results: The mean BP, the percent time elevation index, and the hyperbaric impact decreased in both drug groups. Significant difference was observed in the DI in the case of twice-daily administration vs once-daily evening dosing. Conclusions: The twice-daily administration with the same daily dose of perindopril or losartan seems to be more effective compared to the once daily evening administration in eliminating the non-dipper phenomenon. According to some authors the non-dipping phenomenon increases cardiovascular risk, while others are of the opinion that the association of non-dipping with cardiovascular events does not necessarily mean that selective treatment of non-dipping improves cardiovascular outcomes.

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Section: Introductionmentioning

confidence: 92%

Treatment of Hypertension: Favourable Effect of the Twice-Daily Compared to the Once-Daily (Evening) Administration of Perindopril and Losartan

Ipoly¹,

Csajági

Major

et al. 2015

Kidney Blood Press Res

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“…23,24 Several previous studies reported that they have not only an antihypertensive but also a urinary protein-decreasing effect. [25][26][27] Separately, add-on therapy of spironolactone to RAS inhibitors inhibits the aldosterone breakthrough phenomenon and may lead to renal protection in patients with chronic kidney disease. Sato and colleagues 13,28 demonstrated that add-on therapy of spironolactone to ARB treatment reduced urinary protein in patients with diabetes who experienced the aldosterone breakthrough phenomenon.…”

Section: Ras Inhibitors (Angiotensin-converting Enzyme Inhibitor or Arb)mentioning

confidence: 99%

Antialbuminuric effect of eplerenone in comparison to thiazide diuretics in patients with hypertension

Sawai

Dohi

Fujimoto

et al. 2017

J of Clinical Hypertension

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This study investigated the effects and safety of eplerenone or thiazide diuretics in patients with hypertension and albuminuria (pretreatment urinary albumin/creatinine ratio ≥10 mg/gCr) treated with an angiotensin II receptor blocker . The primary end point was the mean percent change in the urinary albumin/creatinine ratio from baseline to 48 weeks. An efficacy analysis was performed in 195 patients (98 in the eplerenone group and 97 in the thiazide group). Systolic and diastolic blood pressures at 48 weeks were similar in the two groups. The mean percent change in the urinary albumin/creatinine ratio from baseline to 48 weeks was similar in the two groups (P=.804). In the safety analysis, the withdrawal rates for adverse events were similar in both groups. The antialbuminuric effects and safety of eplerenone therapy were similar to those of thiazide diuretics when combined with an angiotensin II receptor blocker in patients with hypertension and albuminuria.

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Triple combination therapy with telmisartan, amlodipine, and hydrochlorothiazide ameliorates albuminuria in a normotensive rat remnant kidney model

et al. 2021

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Background Some types of antihypertensive drugs may have pleiotropic effects in patients with chronic kidney disease (CKD). However, whether triple combination therapy with angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), and thiazide diuretics (TZD) confer renoprotective effects in normotensive CKD remains unknown. Thus, we explored this issue using a normotensive rat remnant kidney model. Methods Sprague-Dawley rats were randomly allocated into four groups: sham (n = 10), 5/6 nephrectomy (NTx) (n = 9), NTx treated with telmisartan and amlodipine (dual) (n = 8), and NTx treated with telmisartan, amlodipine, and hydrochlorothiazide (triple) (n = 7), and followed for 4 weeks. Blood pressure (BP), blood chemistry including renal function, urinary albumin excretion (UAE), and renal pathology were evaluated in all groups. Results There was no significant change in systolic BP among the four groups during the study period. Serum blood urea nitrogen (BUN) was significantly higher, and 24-h creatinine clearance (Ccr) was lower in all NTx groups (p < 0.001). Dual therapy further increased the glomerular diameter in NTx rats (p < 0.001), which was significantly ameliorated by triple therapy (p < 0.001). Triple therapy, but not dual therapy, significantly reduced NTx-induced UAE levels (p < 0.05), whereas BUN, 24-h Ccr, and tubulointerstitial injury scores were comparable among all the NTx groups. Conclusions Our results suggest that triple combination therapy with telmisartan, amlodipine, and hydrochlorothiazide could ameliorate glomerular hypertrophy and albuminuria in normotensive CKD rats in a BP-lowering independent manner.

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Release From Glomerular Overload by the Addition of Low-dose Thiazide in Patients With Angiotensin Receptor Blocker-Resistant Hypertension

Cited by 4 publications

References 31 publications

Treatment of Hypertension: Favourable Effect of the Twice-Daily Compared to the Once-Daily (Evening) Administration of Perindopril and Losartan

Treatment of Hypertension: Favourable Effect of the Twice-Daily Compared to the Once-Daily (Evening) Administration of Perindopril and Losartan

Antialbuminuric effect of eplerenone in comparison to thiazide diuretics in patients with hypertension

Triple combination therapy with telmisartan, amlodipine, and hydrochlorothiazide ameliorates albuminuria in a normotensive rat remnant kidney model

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