Treatment of Proteinuria with Lercanidipine Associated with Renin-Angiotensin Axis-Blocking Drugs

Abstract

Objective. Most calcium antagonists do not seem to reduce microalbuminuria or proteinuria. We have tried to assess the antiproteinuric effect of a calcium channel blocker, lercanidipine, in patients previously treated with ACE inhibitors or angiotensin receptor blockers. Design and Methods. The study included 68 proteinuric (> 500 mg/day) patients (age 63.1 ± 12.9 years, 69.1% males and 30.9 females). All patients were receiving ACE inhibitors (51.4%) or angiotensin II receptor blockers (48.6%) therapy but had higher blood pressure than recommended for proteinuric patients (<130/80 mmHg). Patients were clinically evaluated one, three, and six months after starting treatment with lercanidipine (20 mg/day). Samples for urine and blood examination were taken during the examination. When needed, a third drug was added to treatment. Creatinine clearance was measured using 24 h urine collection. Results. BP significantly decreases from 152 ± 15/86 ± 11 mmHg to 135 ± 12/77 ± 10 mmHg at six months of follow-up (p < 0.001). After six months of treatment, the percentage of normalized patients (BP < 130/80 mmHg) was 42.5%, and the proportion of patients whose BP was below 140/ 90 mmHg was 58.8%. Plasmatic creatinine did not change nor did creatinine clearance. Plasmatic cholesterol also decreased from 210 ± 48 to 192 ± 34 mg/dL (p < 0.001), as did plasma triglycerides (from 151 ± 77 to 134 ± 72 mg/dL, p = 0.022). Basal proteinuria was 1.63 ± 1.34 g/day; it was significantly (p < 0.001) reduced by 23% at the first month, 37% at three months, and 33% at the last visit. Conclusions. Lercanidipine at 20 mg dose, associated to renin-angiotensin axis-blocking drugs, showed a high antihypertensive and antiproteinuric effect. This antiproteinuric effect seems to be dose-dependent as compared with previous reports and proportionally higher than blood pressure reduction.

Effects of Tolvaptan With or Without the Pre-Administration of Renin-Angiotensin System Blockers in Hospitalized Patients With Acute Decompensated Heart Failure

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A modern choice for patients with hypertension: the possibility of new calcium antagonist of III generation

“…В частности, у пациентов с АГ и са-харным диабетом была продемонстрирована большая эффективность такой комбинации, чем сочетания бета-адреноблокатора и иАПФ [52].…”

Some aspects of the modern antihypertensive drug therapy and most common side effects

“…An action on both pre-and post-capillary vasodilatation may underlie the reduced clinical incidence of pedal edema, the most common side effect ofcalcium antagonists, seen with lercanidipine relative to other 1,4-dihydropyridines (19). Addition of lercanidipine to antihypertensive therapy with RAAS blocker leads to further benefits for renal function (10,11). Prescription of third generation CCBs is associated with improvements in adherence and persistence to antihypertensive therapy.…”