Renoprotective Effects of Various Angiotensin II Receptor Blockers in Patients with Early-Stage Diabetic Nephropathy

Abstract

Background: There is increasing evidence that inhibition of the renin-angiotensin system provides renoprotection independent of blood pressure lowering. The aim of the present study was to determine whether various angiotensin II receptor blockers (ARBs) affect urinary albumin excretion (UAE), urinary liver-type fatty acid-binding protein (L-FABP) and 8-hydroxy-2′-deoxyguanosine (8-OHdG) levels in early-stage diabetic nephropathy patients with microalbuminuria. Methods: Sixty-eight diabetic nephropathy patients with microalbuminuria were randomly allocated to 1 of 4 treatment groups: losartan 100 mg/day (group A), candesartan 12 mg/day (group B), olmesartan 40 mg/day (group C), or telmisartan 80 mg/day (group D). Treatment was continued for 12 months. UAE, L-FABP and 8-OHdG excretion, serum creatinine, and 24-hour creatinine clearance (Ccr) were measured. Results: The serum creatinine and 24-hour Ccr were not affected during the experimental period in any of the groups. Systolic and diastolic blood pressures, UAE, urinary L-FABP and 8-OHdG excretion were significantly reduced after 6 and 12 months compared with baseline in any of the groups. ΔL-FABP and Δ8-OHdG were significantly greater in group D than in the other 3 groups after 12 months. Conclusions: ARBs have renoprotection and this effect of telmisartan appears to be more potent than that of losartan, candesartan, or olmesartan in early-stage diabetic nephropathy patients.

Telmisartan improves kidney function through inhibition of the oxidative phosphorylation pathway in diabetic rats

“…Telmisartan acts as a partial agonist of PPARg as well as an inhibit or of the AT1 receptor. Recent research reported that telmisartan attenuates oxidative stress and renal fibrosis in STZ diabetic mice with the alteration of angiotensin-(1-7) Mas receptor expression associated with its PPAR-g agonist action (Nakamura et al 2010). Furthermore, Yao et al (2008) have reported that telmisartan inhibited TGF-b1-induced alpha-smooth muscle actin expression and collagen IV secretion in mesangial cells via the activation of PPAR-g.…”

“…The ONTARGET study has shown that telmisartan provides superior reductions of proteinuria compared with ramipril and is effective in reducing renal endpoints. ARBs have renoprotection and this effect of telmisartan appears to be more potent than that of losartan, candesartan, or olmesartan in early-stage DN patients (Nakamura et al 2010). The INNOVATION study previously showed that treatment with telmisartan effectively reduced the transition from incipient to overt nephropathy in Japanese type 2 DM patients.…”

Evaluation of the Dose-Response Relationship of Amlodipine and Losartan Combination in Patients with Essential Hypertension

“…[19,[25][26][27][28] Combining amlodipine camsylate with losartan may provide superior BP-lowering effects and a low incidence of side effects. The objective of this study (registered at clinicaltrials.gov: NCT00942344) was to determine which dose of the new formulation of amlodipine camsylate (5 mg or 10 mg) combined with losartan (50 mg or 100 mg) would most effectively reduce sitting diastolic BP (DBP) after 8 weeks of treatment in patients with essential hypertension.…”

The Enhanced Renin-Angiotensin-Aldosteron System Pharmacological Blockade - Which is the Best?

“…Angiotensin II and aldosterone are the key players in the development and progression of chronic kidney diseases (CKD), either directly by promoting tissue fibrosis or indirectly through their action on glomerular hemodynamic and enhancing proteinuria [1,2]. Therefore, pharmacological inhibition of the renin-angiotensin-aldosteron system (RAAS) may have a beneficial impact on renal outcome [2,3].…”