Antihypertensive Group Research Articles

Losartan increases bone mass and accelerates chondrocyte hypertrophy in developing skeleton

Angiotensin receptor blockers (ARBs) are a group of anti-hypertensive drugs that are widely used to treat pediatric hypertension. Recent application of ARBs to treat diseases such as Marfan syndrome or Alport syndrome has shown positive outcomes in animal and human studies, suggesting a broader therapeutic potential for this class of drugs. Multiple studies have reported a benefit of ARBs on adult bone homeostasis; however, its effect on the growing skeleton in children is unknown. We investigated the effect of Losartan, an ARB, in regulating bone mass and cartilage during development in mice. Wild type mice were treated with Losartan from birth until 6 weeks of age, after which bones were collected for microCT and histomorphometric analyses. Losartan increased trabecular bone volume vs. tissue volume (a 98% increase) and cortical thickness (a 9% increase) in 6-weeks old wild type mice. The bone changes were attributed to decreased osteoclastogenesis as demonstrated by reduced osteoclast number per bone surface in vivo and suppressed osteoclast differentiation in vitro. At the molecular level, Angiotensin II-induced ERK1/2 phosphorylation in RAW cells was attenuated by Losartan. Similarly, RANKL-induced ERK1/2 phosphorylation was suppressed by Losartan, suggesting a convergence of RANKL and angiotensin signaling at the level of ERK1/2 regulation. To assess the effect of Losartan on cartilage development, we examined the cartilage phenotype of wild type mice treated with Losartan in utero from conception to 1 day of age. Growth plates of these mice showed an elongated hypertrophic chondrocyte zone and increased Col10a1 expression level, with minimal changes in chondrocyte proliferation. Altogether, inhibition of the angiotensin pathway by Losartan increases bone mass and accelerates chondrocyte hypertrophy in growth plate during skeletal development.

Effects of traditional Chinese patent medicine on essential hypertension: a systematic review.

Traditional Chinese patent medicine (TCPM) is widely used for essential hypertension (EH) in China. However, there is no critically appraised evidence, such as systematic reviews or meta-analyses, regarding the potential benefits and disadvantages of TCPM to justify their clinical use and recommendation. The aim of this review was to systematically evaluate and meta-analyze the effects of TCPM for EH.Seven databases, the Cochrane Library, PubMed, EMBASE, the China National Knowledge Infrastructure, the Chinese Scientific Journal Database, the Chinese Biomedical Literature Database, and the Wanfang Database, were searched from their inception to August 2014 for relevant studies that compared one TCPM plus antihypertensive drugs versus antihypertensive drugs alone. The methodological quality of the included trials was assessed using the Cochrane risk-of-bias tool. The primary outcome measures were mortality or progression to severe complications and adverse events. The secondary outcome measures were blood pressure (BP) and quality of life (QOL).Seventy-three trials, which included 8138 patients, on 17 TCPMs were included. In general, the methodological quality was low. Two trials evaluated the effects of TCPMs on mortality and the progression to severe complications after treatment, and no significant difference was identified compared with antihypertensive drugs alone. No severe adverse events were reported. Thirteen TCPMs used in complementary therapy significantly decreased systolic BP by 3.94 to 13.50 mmHg and diastolic BP by 2.28 to 11.25 mmHg. QOL was significantly improved by TCPM plus antihypertensive drugs compared with antihypertensive drugs alone.This systematic review provided the first classification of clinical evidence for the effectiveness of TCPM for EH. The usage of TCPMs for EH was supported by evidence of class level III. As a result of the methodological drawbacks of the included studies, more rigorously designed randomized controlled trials that focus on mortality and cardiovascular events during long-term follow-up are warranted before TCPM can be recommended for hypertensive patients. Two TCPMs, Song ling xue mai kang capsules and Yang xue qing nao granules, should be prioritized for further research.

Chinese herbal medicine for resistant hypertension: a systematic review

ObjectivesThis study aimed to summarise the current evidence from randomised control trials (RCTs) concerning treatment of patients with resistant hypertension with Chinese herbal medicine (CHM).DesignSeven databases, including the Cochrane Library,...

Сочетание артериальной гипертонии и ишемической болезни сердца – проблема номер один современной кардиологической практики

This article deals with the epidemiological datashowing higher frequency of arterial hypertension (AH) in patients with ischemic heart disease (IHD). We discussed the basic characteristics of modern domestic and foreign recommendations for treating patients with combination of AH and IHD. We showed the target of blood pressure (BP) in this category of patients. This article deals with the priority groups of antihypertensive drugs, which have the advantages in the combination usage in patients with association of these diseases. We fixed special attention to the problem of BP variability (BPV) as a new risk factor for the development of coronary complications in patients with AH. We showed the possibility of fixed combination of perindopril and amlodipine in reducing interand intervisit BPV in patients with AH and IHD in actual clinical practice.

A prospective drug use evaluation of antihypertensive drugs in in-patients of a tertiary referral care hospital.

Hypertension is a chronic illness associated with high morbidity and mortality. Once hypertension is diagnosed, starting antihypertensive therapy on a long-term basis along with regular follow up is important. Standardizing treatment guidelines and conducting drug utilization studies at regular intervals help physicians to prescribe drugs rationally. The present study was conducted to analyze the prescription patterns of antihypertensive drugs in a tertiary care referral hospital in Malabar region, Kerala, India. The study was conducted at the General Medicine and Cardiology Department involving the in-patients. Patients suffering from essential hypertension with or without other co-morbidities were included in the study. The frequency and proportion of prescribing different groups of antihypertensive drugs as monotherapy or combination therapy, and prescription of fixed drug combinations (FDCs) were analyzed. A total of 200 hypertensive patients were included in the study. Patient data were collected from in-patient's case sheets and direct interviews with the patients and their observers. The majority of the patients were females with 56%, whereas the males comprised 44%, with most of the patients suffering from stage-II hypertension. The study revealed that a high proportion of the hypertensive patients had co-morbid diabetes mellitus. The most commonly prescribed class of antihypertensive drugs was angiotensin receptor blockers, followed by calcium channel blockers and β-blockers. With regard to patient therapy, 32.0% received monotherapy, whereas 68.0% received combination therapy, 16% of which received FDCs. The study shows that clinical pharmacists can play a key role in promoting rational prescription and improving adherence to medication.

The impact of combinations of non-steroidal anti-inflammatory drugs and anti-hypertensive agents on blood pressure.

Nowadays NSAIDs are the most frequently used groups of drugs, especially because of their availability. Their consumption is high among older people, who are much more sensitive to the side effects, and who are often also taking other drugs which can interact with them. Moreover, the majority of the older population is suffering from hypertension. This could well explain the commonly encountered experience of drug interaction between NSAIDs and antihypertensive drugs, which is very common in clinical practice. The severity of this drug interaction is classified as class C, with arecommendation to monitor therapy. However, even aminor long-term increase in blood pressure can significantly increase the risk of cardiovascular mortality, while mortality rates can possibly be reduced by sufficiently effective treatment of hypertension. Therefore, in clinical practice, this type of interaction should not be overlooked as amajor cause of failure of hypertension treatment in older patients, as well in many cases in general. The present article focusses on the mechanism and the degree of influence on the blood pressure of particular types of antihypertensive agents used in combination with NSAID.Not all groups of antihypertensive drugs are affected to the same degree; some are more affected, and others, such as calcium channel blockers, are not affected at all. Similarly, not every NSAID increases blood pressure. Many studies, some of which are analyzed in this article, present evidence of the degree of the influence NSAIDs have on blood pressure.

THE FEATURES OF ANTIHYPERTENSIVE THERAPY IN PATIENTS WITH METABOLIC SYNDROME

Arterial hypertension (HT) in patients with metabolic syndrome has features (early damage of target organ, a predisposition to thrombosis, refractory to standard antihypertensive therapy, high cardiovascular risk). The aim of HT treatment in patients with metabolic syndrome includes not only the achievement of target blood pressure, but also a reduction of target organ damage, correction of modifiable risk factors and associated clinical conditions. Results of multicenter studies on assessment of clinical efficacy of groups of antihypertensive drugs, their effects on metabolic parameters, the ability to prevent the development of cardiovascular events, diabetes mellitus, and renal dysfunction are presented.

Comparative characterizations of patients with hypertensive disease in the mid-1980s and in the 2010s (the patients’ portraits in the context of factor analysis)

Aim: to study the clinical characteristics of patients with hypertensive disease (HD) in the first decade of the 21st century versus the mid-1980s, by using multivariate statistical methods for the further optimization of therapeutic and diagnostic guidelines. Materials and methods. 234 case histories of patients with HD in the periods 1985 to 1987 (Group 1) and 2010–2012 (Group 2) were analyzed. Factor analysis of 110 signs identified 7 factors or leading symptom complexes. Results. Comparison of HD patients’ portraits in the mid-1980s and the first decade of the 21st century may lead to a number of main conclusions: firstly, HD has undergone certain alternations in the past quarter of a century, which is associated with changes in both the socioeconomic characteristics of society and those in approaches to therapy and with the advent of novel groups of antihypertensive drugs; secondly, the emergence of drugs with a proven nephroprotective effect (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers) resulted in the reduced negative impact of BP on renal functions. Thus, three of the seven factors in Group 1 are directly related to the renal function of patients with HD while Group 2 shows only one factor of systemic and intraglomerular hypertension; thirdly, metabolic disturbances assume great importance in the characterization of Group 2 patients. Metabolic syndrome is typical of them; fourthly, for the patients of the early 21st century, of particular significance is tobacco smoking that is not only a risk factor of cardiovascular diseases in general, but also a factor influencing of the diurnal BP variation that promotes the formation of its particularly unfavorable variants – a night peaker, and finally fifthly, the patients of the early 21st century are characterized by a greater adherence to systemic antihypertensive therapy, which positively affects primarily on the course of the disease, by preventing target organ damage. Conclusion. The findings make it possible to optimize therapeutic and diagnostic efforts in patients with HD and to make more goal-oriented secondary prevention of complications.

Real and potential benefits of third-generation calcium antagonists

The paper considers the specific features of the pharmacokinetics of third-generation dihydropyridines (membrane-controlled pharmacokinetics). Comparative trials have shown their longer action and high efficacy, which are highly competitive with those of major groups of antihypertensive drugs. Lercanidipine proved to have the nephroprotective activity comparable with that of angiotensin-converting enzyme (ACE) inhibitors. They have been demonstrated to have a better tolerance and safety than second-generation calcium antagonists.

Effects of long term nasal continuous positive airway pressure on the blood pressure of patients with obstructive sleep apnea hypopnea syndrome

To analyze the effects of long term nasal continuous positive airway pressure on the blood pressure of patients with OSAHS. From April 1997 to October 2008, 2898 patients from the First Affiliated Hospital of Fujian Medical University who complained snore during sleeping were studied. Nine hundred eighty cases were diagnosed as OSAHS with hypertension, and these patients were randomly divided into 2 groups: one group was treated with antihypertensive drugs and nasal continuous positive airway pressure (nCPAP), while the other group only received antihypertensive drugs. The polysomnography (PSG) was recorded during sleeping and the blood pressure was remeasured after 6 months or more. All patients were followed up for 5 years to observe the long-term effects of nCPAP or drugs. Systolic and diastolic blood pressure in the nCPAP group significantly decreased after 6 months [(125 ± 16) mm Hg (1 mm Hg = 0.133 kPa) vs (136 ± 19) mm Hg, (83 ± 10) mm Hg vs (95 ± 15) mm Hg, P < 0.05], and the decreasing extent of blood pressure in nCPAP group was more notable than antihypertensive drug group [decreasing extent of systolic blood pressure:(10 ± 11) mm Hg vs (4 ± 11) mm Hg; decreasing extent of diastolic blood pressure: (11 ± 7) mm Hg vs (6 ± 7) mm Hg; P < 0.05]. The total effective rate in nCPAP group was significantly higher than that in antihypertensive drug group (90% vs 38%, P < 0.01). One hundred and eighty three cases in nCPAP group and 157 cases in antihypertensive drug group completed the 5-year follow-up and the blood pressure was controlled within the normal range. Some patients could gradually reduce or stop the use of antihypertensive drugs and the blood pressure didn't appear to rebound. The number of antihypertensive drugs in the nCPAP group was significantly fewer as compared to the antihypertensive drugs group after 2, 3, 4 and 5 years' follow-up. nCPAP is a safe and effective treatment for high blood pressure in patients with OSAHS.

1071 Gender differences in 24-hour blood pressure regulation in hypertensive patients with coronary atherosclerosis confirmed in angiography

Introduction: More and more evidence indicate that gender plays important role in hypertension and coronary atherosclerosis pathogenesis. The aim of our study was to assess 24-hour blood pressure profile in hypertensive men and women with established coronary atherosclerosis. Methods: We enrolled 891 patients with hypertension and coronary atherosclerosis confirmed in coronary angiography (at least one coronary stenosis ≥70%), divided into two groups: women, n = 276, mean age 66.4 ± 8.4 and men, n = 615, mean age 62.5 ± 9.5. Reverse dipper, Dipper, Non-dipper and Extreme dipper profiles were defined according to night fall of systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results: Higher values of only DBP were observed in men in comparison to women as follows: 24-h (72.7 ± 8.3 mmHg vs. 68.5 ± 8.1 mmHg, p < 0.01), daytime (75.4 ± 8.6 mmHg vs. 71.4 ± 8.6 mmHg, p < 0.01) and nighttime (68.2 ± 9.0 mmHg vs. 63.7 ± 8.4 mmHg, p < 0.01). Our study revealed higher mean nocturnal/diurnal ratio (nighttime/daytime BP values) in men than women only for DBP (0.91 ± 0.06 vs. 0.89 ± 0.07, p < 0.02). There was lower prevalence of dippers in men than in women (39.7% vs. 47.8%, p < 0.02). The most common profiles were as follows: in men – non-dipper (43.2%) and in women – dipper (47.8%). The men group and the women group did not differ in treatment of hypertension (assessed either as number of antihypertensive agents or prevalence of using particular groups of antihypertensive drugs). Conclusion: Gender influences blood pressure regulation in patients with hypertension and coronary atherosclerosis. Dipper profile is more characteristic for women than for men.

BETA-BLOCKERS IN THE TREATMENT OF ARTERIAL HYPERTENSION: EVIDENCE BASED DATA AND REAL PRACTICE

Data of the largest meta-analyzes of beta-blockers use in arterial hypertension is presented. The role of beta-blockers among other basic groups of antihypertensive drugs (thiazide diuretics, calcium channel blockers, ACE inhibitors) is evaluated. Special considerations of beta-blockers use in hypertensive patients with diabetes mellitus and chronic heart failure are discussed. Special attention is paid to bisoprolol.

Differential clinical profile of candesartan compared to other angiotensin receptor blockers

The advantages of blood pressure (BP) control on the risks of heart failure and stroke are well established. The renin-angiotensin system plays an important role in volume homeostasis and BP regulation and is a target for several groups of antihypertensive drugs. Angiotensin II receptor blockers represent a major class of antihypertensive compounds. Candesartan cilexetil is an angiotensin II type 1 (AT[1]) receptor antagonist (angiotensin receptor blocker [ARB]) that inhibits the actions of angiotensin II on the renin-angiotensin-aldosterone system. Oral candesartan 8–32 mg once daily is recommended for the treatment of adult patients with hypertension. Clinical trials have demonstrated that candesartan cilexetil is an effective agent in reducing the risk of cardiovascular mortality, stroke, heart failure, arterial stiffness, renal failure, retinopathy, and migraine in different populations of adult patients including patients with coexisting type 2 diabetes, metabolic syndrome, or kidney impairment. Clinical evidence confirmed that candesartan cilexetil provides better antihypertensive efficacy than losartan and is at least as effective as telmisartan and valsartan. Candesartan cilexetil, one of the current market leaders in BP treatment, is a highly selective compound with high potency, a long duration of action, and a tolerability profile similar to placebo. The most important and recent data from clinical trials regarding candesartan cilexetil will be reviewed in this article.

Effects of Olmesartan in Hypertensive Patients with History of Paroxysmal Atrial Fibrillation

Background: J-RHYTHM II study has shown that treatment of hypertension suppressed episodes of paroxysmal atrial fibrillation (AF) in patients with hypertension with the history of AF. The effect of lowering blood pressure by olmesartan on AF burden, vascular inflammation markers, and autonomic nerve activity is unknown. Methods: In this prospective study of 40 cases of essential hypertension with history of paroxysmal atrial fibrillation, including 17 with new administration of olmesartan (Group A) and 23 with substituting olmesaltan for other antihypertensive drug (Group B), Holter electrocardiogram, ambulatory blood pressure monitoring and a panel of vascular inflammation markers were performed before and after 6-month administration of olmesartan. All patients were followed by using daily portable ECG recordings in spite of symptoms (twice ECG/day), and were encouraged to submit further ECGs in any case of symptoms. Results: In group A, blood pressure was significantly lower (Systolic blood pressure; 147±15 mmHg vs 127±16 mmHg, p<0.05, Diastolic blood pressure; 79±11 mmHg vs 73±9 mmHg, p<0.05), but AF burden was not decreased (11±25% vs 6±13%, p=NS) at the follow-up period with olmesartan 14.4±6.5 mg. In group B, blood pressure was not significantly changed and AF burden was not decreased. In both groups, vascular inflammation markers and autonomic function did not significantly change. In conclusion, Treatment with olmesartan was not associated with a reduction in the incidence of recurrent AF.

A comparison of the effects of ramipril and losartan on blood pressure control and left ventricle hypertrophy in patients with autosomal dominant polycystic kidney disease

Background: Hypertension is frequently seen in autosomal dominant polycystic kidney disease (ADPKD), and it has a negative effect on renal progression. Hypertension and left ventricle hypertrophy (LVH) are related in terms of pathogenesis and their effects on renal progression. In this study, we aimed to compare the effects of losartan and ramipril on blood pressure (BP) control, LVH, and renal progression in patients with hypertensive ADPKD. Methods: Thirty-two ADPKD patients with ages ranging between 18 and 70 years who were stage 1–2 hypertensive were included in this study. Routine biochemical tests and echocardiography were obtained at first examination of the patients. Following these, the patients were randomized. One group was given losartan and the other ramipril. They were followed up for 1 year, and their echocardiographies and routine biochemical tests were repeated at the end of the year. Results: BP values decreased in both the groups at the end of the first year (p < 0.001). There was a statistically significant difference in LVH in both the groups at the end of the first year than at the beginning (losartan, p = 0.007; ramipril, p < 0.001). Conclusions: In this study, effective BP control was obtained with losartan and ramipril and LVH was found to be regressed significantly in the hypertensive patients with ADPKD. These two groups of antihypertensive drugs may also have beneficial effects on the retardation of renal progression and in reducing cardiovascular mortality in hypertensive patients with ADPKD.

THERAPEUTIC DECISIONS IN THE MANAGEMENT OF ARTERIAL HYPERTENSION IN POLAND - THE INFLUENCE OF COMPLICATIONS AND CHOSEN COMPELLING INDICATIONS - RESULTS OF THE DETENT STUDY: PP.19.257

Objective: The aim of the DETENT study was to assess the influence of concomitant diseases and hypertensive complications on the choices made by cardiologists and primary care physicians (PCP) in antihypertensive pharmacotherapy in Polish population. Design and Method: Study was designed as an all-Poland epidemiological survey in which 177 cardiologists and 434 PCP took part. Every participant filled in a form for 40 consecutive patients with arterial hypertension (AH). Results: Data was collected for 24451 patients (49.8%M). 29% (7088; 53.1%M) treated by cardiologists and 71% (17363; 48.4%M) treated by PCP. Mean age 60.4 ± 12 years. The incidence of coexisting diseases: hypercholesterolemia 63.4%, diabetes 27.4%, obesity (BMI >29,9 kg/m2) 29.5%, ischemic heart disease 40.9%, myocardial infarction 21.4%, stroke 6.4%, heart failure 17.8%, kidney dysfunction 7.5%, chronic kidney disease 4.8%, benign prostate hyperplasia 10.1%, hyperthyroidism 4.7%. 8.5% of patients had uncomplicated AH. Most often used groups of antihypertensive drugs in the whole study population were ACE-Is (80.8%), beta-blockers (75.2%) and diuretics (51.3%). Depending on type and number of coexisting states incidence of treatment with groups of antihypertensives, sequence of their implementation, range of doses (min./medium/max.) and achieved BP control (acc.to ESC/ESH2007) were assessed. Conclusions: In the DETENT study the 3 most often used groups of drugs were ACE-Is, beta-blockers and diuretics, regardless of type of coexisting disease. Only patients with prostate hyperplasia (alpha-blockers were third), hyperthyroidism or with uncomplicated AH (beta-blockers were most often used) were the exception. Observed trends of drug choice seem to follow the guidelines, but still too high percentage of patients is not given drugs basic for important concomitant diseases. Relatively small number of patients was given drugs in maximum doses. Goal values of BP were achieved only in 11.2%. BP values <130/80 mmHg in case of concomitant diseases bound up with high and very high cardiovascular risk were achieved in less then 6% of patients. Increasing number of complications and concomitant diseases lowered the percentage of patients with BP control.

COMPARATIVE STUDY OF ANTIHYPERTENSIVE DRUG REGIMENS AND MORTALITY IN THE GLASGOW BLOOD PRESSURE CLINIC: 2B.01

Aim: To investigate the relationship between antihypertensive regimen and mortality in a long-term follow up study of hypertensive patients attending a secondary tertiary referral centre. Methods: We studied the effects of various antihypertensive treatment regimens on mortality at the Glasgow Blood Pressure Clinic (GBPC). Patients were classified according to treatment regimen maintained for the longest period of time between years 2 and 5 of follow up. Classification was based on the 4 major antihypertensive drug groups: ACEi/ARB (A); beta-blockers (B); calcium antagonists (C); diuretics (D). Treated patients not on any ABCD drug were grouped into one category. Survival analyses were performed using Cox proportional hazards model. Covariates included age, sex, BMI, cholesterol, achieved systolic BP, smoking and epoch defined by publication of major UK hypertension treatment guidelines. Results: During 20 years of follow up, there were 1546 deaths among the 5467 patients included in the study (mean age = 53 years, males = 48% at baseline). The mean reduction in BP pressure during follow up was 25 ± 28 mmHg. Despite adjustment for achieved BP, patients on BD combination showed the highest mortality, while patients on AD had the lowest mortality. Compared with AD combination, all of the other regimens were associated with higher mortality (Figure). Conclusion: In this GBPC cohort, AD combination is associated with lower all-cause mortality when compared to all other antihypertensive drug strategies.

A comparison of two methods for measuring anti-hypertensive drug use: concordance of use with South African standard treatment guidelines

To assess prescriber adherence to standard anti-hypertensive treatment guidelines in South Africa, determine if supply data are useful indicators of drug use, and assess the cost implications of not complying with the guidelines. We undertook two studies: an analysis of records of the anti-hypertensive drugs supplied to all 54 public-sector hospitals with a hypertension clinic in KwaZulu-Natal, and a direct-observation survey of anti-hypertensive drug prescriptions presented to pharmacies in a subset of 16 of the 54 hospitals. We calculated the relative use of each anti-hypertensive drug group as a proportion of all anti-hypertensive drugs supplied or prescribed. We ranked drug groups in order of use for comparison with recommended South African standard treatment guidelines, and we compared the proportions derived from supply data with those derived from the prescription survey. Supply data showed that, in line with treatment guidelines, diuretics and angiotensin-converting enzyme inhibitors were the most frequently supplied medicines (42% and 27%, respectively). However, methyldopa - not included in the treatment guidelines - represented 10% of all anti-hypertensives supplied, but the proportion varied widely between hospitals (0-37%). Reserpine, second choice in the treatment guidelines, was used in high amounts by only two hospitals. Calcium channel blockers and beta blockers represented a small proportion of the anti-hypertensive drugs supplied: 6% each. Results from the prescription survey were in concordance with supply data for the most frequently prescribed drugs but gave slightly different estimates of the use of others. Supply data, the most available source of information about drug use in developing countries, are (with some provisos) a reliable data source for the evaluation of adherence to treatment guidelines. Our results showed substantial non-adherence to standard treatment guidelines.

Renoprotective effect of calcium channel blockers

The advancing chronic renal failure is at most the consequence of secondary haemodynamic and metabolic factors as intraglomerular hypertension and glomerular hypertrophy. Although tight blood pressure control is the major preventive mechanism for progressive renal failure, ACE inhibitors and angiotensin receptor blockers have some other renoprotective mechanisms beyond the blood pressure control. That is why these two groups of antihypertensive drugs traditionally have advantages in treating renal patients especially those with proteinuria over 400-1000 mg/day. Even if earlier experimental studies have shown renoprotective effect of calcium channel blockers, later clinical studies did not prove that calcium channel blockers have any advantages in renal protection over ACE inhibitors given as monotherapy or in combination with ACE inhibitors. It was explained by action of calcium channel blockers on afferent but not on efferent glomerular arterioles; a well known mechanism that leads to intraglomerular hypertension. New generations of dihydropiridine calcium channel blockers can dilate even efferent arterioles not causing unfavorable haemodynamic disturbances. This finding was confirmed in clinical studies which showed that renoprotection established by calcium channel blockers was not inferior to that of ACE inhibitors and that calcium channel blockers and ACE inhibitors have additive effect on renoprotection. Newer generation of dihydropiridine calcium channel blockers seem to offer more therapeutic possibilities in renoprotection by their dual action on afferent and efferent glomerular arterioles and, possibly by other effects beyond the blood pressure control.

Antiproteinuric effects of antihypertensive agents in non-diabetic hypertensive population

Abstract Arterial hypertension and proteinuria are important factors associated with the progression of both diabetic and nondiabetic chronic kidney disease. The objective of the present study was to determine the influence of different antihypertensive drug groups on urinary albumin excretion (UAE) as related to blood pressure in non-diabetic population. Subjects (n=39) with chronic renal disease accompanied by mild to moderate hypertension and varying degrees of proteinuria were divided into 3 groups based on UAE values and placed on nonpharmacological and/or treatment with an antihypertensive drug regimen (consisting of one or more antihypertensive drugs [beta blocker, ACE inhibitor or calcium-channel blocker]) to achieve a target blood pressure ≤ 130/85 mmHg. Periodic UAE measurements were performed. A reduction was observed over time in most patients, however, it reached statistical significance only in the microalbuminuric group (P&lt;0.01). Patients were further stratified into 5 groups depending on assigned therapy: 0, nonpharmacological treatment; 1-drug group 1; 12-drug groups 1 and 2; 13-drug groups 1 and 3; 123-all 3 drug groups (1-ACE inhibitors, 2-beta blockers, 3-calcium channel blockers). A statistically significant change in mean UAE values at the start and end of the study period in patients assigned to drug groups 12, 13, and 123 was achieved (P &lt; 0.05). Also, there was a statistically significant difference in the average reduction of proteinuria under varying antihypertensive drug regimens (P &lt; 0.05). In conclusion, in patients with hypertension, changes in UAE depend on initial UAE values and administered antihypertensive treatment. ACE inhibitors combined with calcium channel blockers resulted in a higher UAE reduction than other drug groups.