The progression rate of chronic renal failure with hypertension and proteinuria can be slowed by treatment with angiotensin converting enzyme inhibitors

Piccoli, Antônio; Favaro, Enrico; Piva, Michele; Bisetto, F; Calzavara, P; Arduini, Remo; Nordio, Maurizio; Stoppa, Fabrizio; Roncali, Davide; Pillon, Luana

doi:10.1016/s0011-393x(05)80790-8

Cited by 4 publications

(2 citation statements)

References 10 publications

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“…Thus, a negative effect of the CCB compared to the ACE inhibitor cannot be excluded. Indeed, in the study of Piccoli et al [136] the 31 patients treated with dihydropyridine calcium channel blockers had a faster decline in renal function than the 31 patients treated with enalapril. The average decrease in proteinuria was greater in the ACE inhibitor group than in the DHP group.…”

Section: Effects On the Course Of Renal Functionmentioning

confidence: 97%

Antihypertensive treatment of patients with proteinuric renal diseases: Risks or benefits of calcium channel blockers?

Kloke¹,

Branten²,

Huysmans³

et al. 1998

Kidney International

115

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In patients with proteinuric renal diseases the rate of progression of renal insufficiency is determined by the level of blood pressure and proteinuria. It has been demonstrated that strict blood pressure control with angiotensin converting enzyme (ACE)-inhibitors or beta-blockers, aimed at reaching values below 130/80 mm Hg, attenuates the deterioration of renal function. In general, the beneficial effects of these drugs are reflected in a parallel lowering of proteinuria. Calcium channel blockers are effective antihypertensive drugs, however, their safety in patients with proteinuric renal diseases and renal insufficiency may be questioned because of reported untoward effects on urinary protein excretion. The present review discusses the potential benefits and risks of calcium channel blockers (CCBs) in the treatment of patients with renal diseases. To this end we have evaluated the effects of these drugs in animal models of progressive renal injury. In these animal models adverse effects of CCBs have been reported which are attributed to an impairment of autoregulation. In patients with proteinuria, the dihydropyridine CCBs do not lower proteinuria despite a reduction of blood pressure. Studies on the effects on the course of renal function are limited, however, the available data do suggest that this class of CCBs may be less advantageous than other antihypertensive drugs, thus arguing against the use of these agents as first-line drugs in patients with proteinuric renal diseases. Information on the effects of the non-dihydropyridine CCBs is limited to a small number of studies in patients with diabetic renal disease. Although the data suggest that these classes of CCBs might be more beneficial, more studies are needed, particularly in patients with non-diabetic renal diseases, before founded conclusions can be reached.

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Section: Effects On the Course Of Renal Functionmentioning

confidence: 97%

Antihypertensive treatment of patients with proteinuric renal diseases: Risks or benefits of calcium channel blockers?

Kloke¹,

Branten²,

Huysmans³

et al. 1998

Kidney International

115

View full text Add to dashboard Cite

show abstract

“…A few studies have compared the DHP CCBs versus ACE inhibitors for periods of greater than 1 year and the results have been contradictory. Both a lack of significant difference between ACE inhibitors and the CCBs [40] and a faster rate of renal function loss with the CCBs [41] have been observed. Of note, only small BP reductions were observed when CCB did worse than ACE inhibitors, whereas larger BP reductions were achieved when comparable benefits were seen.…”

Section: Effects On Rate Of Loss Of Renal Functionmentioning

confidence: 99%

Calcium-channel blockers and the progression of renal disease

Griffin

Bidani

1999

Current Science Inc

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Effective blood pressure (BP) reduction is now generally recognized as a clinically proven strategy to retard the seemingly inexorable downhill progression of patients with diabetic and nondiabetic chronic renal disease. Although calcium-channel blockers (CCBs) are effective antihypertensive agents, the available experimental and clinical data are quite contradictory as to whether BP reduction achieved with CCBs provides the expected renoprotection. Blockade of the "L" type, voltage-gated Ca channels that mediate the BP reduction also concurrently impairs renal autoregulatory responses of the preglomerular vasculature. Because these renal autoregulatory resistance changes provide the primary protection against the transmission of systemic hypertension to the renal microvasculature, the adverse effects of CCBs on renal autoregulation counteract the beneficial effects on BP reduction. The degree of renoprotection achieved, therefore, depends on the balance between these two opposing effects. The data also indicate that there are probably important and clinically relevant differences between the classes of CCBs, with the dihydropyridine (DHP) CCBs most likely to have consistent deleterious effects on renal autoregulation. However, the available data also indicate that the adverse effects of DHP CCBs are not likely to be observed if BP is lowered well into the normotensive range, possibly through the use of combination therapies. Even when used as adjunctive therapy, close monitoring may be advisable to ensure BP normalization and the absence of any untoward effects on proteinuria and renal function.

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Long-term Effects of Antihypertensive Agents on Proteinuria and Renal Function

Maki¹

1995

Arch Intern Med

228

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Long-term beneficial effects of antihypertensive agents on proteinuria and glomerular filtration rate are proportional to blood pressure reductions and are similar in diabetic and nondiabetic patients with renal disease. In addition, angiotensin-converting enzyme inhibitors, and possibly nondihydropyridine calcium antagonists, have additional beneficial effects on proteinuria that are independent of blood pressure reductions.

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The progression rate of chronic renal failure with hypertension and proteinuria can be slowed by treatment with angiotensin converting enzyme inhibitors

Cited by 4 publications

References 10 publications

Antihypertensive treatment of patients with proteinuric renal diseases: Risks or benefits of calcium channel blockers?

Antihypertensive treatment of patients with proteinuric renal diseases: Risks or benefits of calcium channel blockers?

Calcium-channel blockers and the progression of renal disease

Long-term Effects of Antihypertensive Agents on Proteinuria and Renal Function

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