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- Title
Effects of combined ACE inhibitor and angiotensin II antagonist treatment in human chronic nephropathies.
- Authors
Campbell, Ruth; Sangalli, Fabio; Perticucci, Elena; Aros, Claudio; Viscarra, Cecilia; Perna, Annalisa; Remuzzi, Andrea; Bertocchi, Federico; Fagiani, Luca; Remuzzi, Giuseppe; Ruggenenti, Piero
- Abstract
<bold>Background: </bold>Proteinuria predicts renal disease progression, and its reduction by angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor antagonists (ARA) is renoprotective.<bold>Methods: </bold>In this prospective, randomized, cross-over study of 24 patients with nondiabetic, chronic nephropathies, we compared the effects on proteinuria, renal hemodynamics, and glomerular permselectivity of 8 weeks with comparable blood pressure control achieved by benazepril (10 mg/day) and valsartan (80 mg/day) combined therapy with those achieved by benazepril (20 mg/day) or valsartan (160 mg/day) alone.<bold>Results: </bold>Despite comparable changes in blood pressure and glomerular filtration rate (GFR), combined therapy decreased proteinuria more than benazepril (-56% vs. -45.9%, P=0.02) and valsartan (-41.5%, P=0.002). Changes in urinary protein to creatinine ratio followed the same trend. Filtration fraction and renal vascular resistances (RVR) decreased more with combined (-14.7%,-23.7%) or benazepril (-12.4%, -20.5%) than with valsartan (-2.7%, -12.5%, P < 0.05 vs. both). RVR changes, adjusted for GFR changes, were associated with those in proteinuria (P < 0.05). Changes in glomerular permeability were comparable and did not predict different changes in proteinuria in the three groups.<bold>Conclusion: </bold>At comparable blood pressure, combined ACEi and ARA decreased proteinuria better than ACEi and ARA. The greater antiproteinuric effect most likely depended on an ACEi-related hemodynamic effect, in addition to glomerular size selectivity amelioration. Long-term combined ACEi and ARA therapy may be more renoprotective than treatment with each agent alone.
- Subjects
KIDNEY disease treatments; ACE inhibitors; ANGIOTENSIN-receptor blockers; ANALYSIS of variance; COMBINATION drug therapy; CHRONIC diseases; COMPARATIVE studies; CROSSOVER trials; DEXTRAN; GLOMERULAR filtration rate; GLOMERULONEPHRITIS; HETEROCYCLIC compounds; ANTIHYPERTENSIVE agents; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; PROTEINURIA; RESEARCH; STATISTICAL sampling; VALINE; RENAL circulation; EVALUATION research; RANDOMIZED controlled trials
- Publication
Kidney International, 2003, Vol 63, Issue 3, p1094
- ISSN
0085-2538
- Publication type
journal article
- DOI
10.1046/j.1523-1755.2003.00832.x