TY - JOUR
T1 - Urinary albumin excretion during angiotensin II receptor blockade
T2 - Comparison of combination treatment with a diuretic or a calcium-channel blocker
AU - Matsui, Yoshio
AU - Eguchi, Kazuo
AU - Ishikawa, Joji
AU - Shimada, Kazuyuki
AU - Kario, Kazuomi
N1 - Funding Information:
Supplementary material is linked to the online version of the paper at http:// www.nature.com/ajh Acknowledgments:The J-CORE study was supported by Jichi Medical University School of Medicine. We thank the nurses (AT and AK) for their assistance with the study.
PY - 2011/4
Y1 - 2011/4
N2 - BackgroundWe aimed to test the hypothesis that the angiotensin II receptor blocker (ARB)/diuretic combination decreases the urinary albumin/creatinine ratio (UACR) to a greater extent than treatment with the ARB/calcium-channel blocker (CCB) combination through a mechanism related to a greater reduction of sleep blood pressure (BP).MethodsWe conducted a prospective, randomized, open-label, blinded end-point trial in hypertensive patients. Patients received olmesartan monotherapy for 12 weeks, followed by an additional use of hydrochlorothiazide (HCTZ) (n = 104) or azelnidipine (n = 103) for 24 weeks after randomization. The measurements of central and ambulatory BP, and laboratory tests were performed at baseline and the end of the study.ResultsThe adjusted percent reduction in UACR in the olmesartan/HCTZ group was significantly greater than that in the olmesartan/azelnidipine group (43.2 vs. 24.0%, P = 0.0014), although the olmesartan/azelnidipine group showed greater decreases in central systolic BP (SBP; P = 0.04), oxidative stress (urinary 8-isoprostane; P = 0.02), inflammation (high-sensitivity C-reactive protein; P = 0.04), and insulin resistance (the homeostasis model assessment insulin resistance index (HOMA IR); P 0.001) than the olmesartan/HCTZ group. In multivariate regression analyses, the significant determinants of change in UACR in the olmesartan/HCTZ group were changes in sleep SBP (P 0.001), central SBP (P = 0.01), estimated glomerular filtration rate (eGFR) (P = 0.02), and HOMA IR (P = 0.03), and those in the olmesartan/azelnidipine group were changes in central SBP (P = 0.001) and urinary 8-isoprostane (P = 0.02).ConclusionsThese data showed that the ARB/diuretic combination decreased UACR significantly more than the ARB/CCB combination, and this decrease in UACR was associated with a greater magnitude reduction in sleep SBP.
AB - BackgroundWe aimed to test the hypothesis that the angiotensin II receptor blocker (ARB)/diuretic combination decreases the urinary albumin/creatinine ratio (UACR) to a greater extent than treatment with the ARB/calcium-channel blocker (CCB) combination through a mechanism related to a greater reduction of sleep blood pressure (BP).MethodsWe conducted a prospective, randomized, open-label, blinded end-point trial in hypertensive patients. Patients received olmesartan monotherapy for 12 weeks, followed by an additional use of hydrochlorothiazide (HCTZ) (n = 104) or azelnidipine (n = 103) for 24 weeks after randomization. The measurements of central and ambulatory BP, and laboratory tests were performed at baseline and the end of the study.ResultsThe adjusted percent reduction in UACR in the olmesartan/HCTZ group was significantly greater than that in the olmesartan/azelnidipine group (43.2 vs. 24.0%, P = 0.0014), although the olmesartan/azelnidipine group showed greater decreases in central systolic BP (SBP; P = 0.04), oxidative stress (urinary 8-isoprostane; P = 0.02), inflammation (high-sensitivity C-reactive protein; P = 0.04), and insulin resistance (the homeostasis model assessment insulin resistance index (HOMA IR); P 0.001) than the olmesartan/HCTZ group. In multivariate regression analyses, the significant determinants of change in UACR in the olmesartan/HCTZ group were changes in sleep SBP (P 0.001), central SBP (P = 0.01), estimated glomerular filtration rate (eGFR) (P = 0.02), and HOMA IR (P = 0.03), and those in the olmesartan/azelnidipine group were changes in central SBP (P = 0.001) and urinary 8-isoprostane (P = 0.02).ConclusionsThese data showed that the ARB/diuretic combination decreased UACR significantly more than the ARB/CCB combination, and this decrease in UACR was associated with a greater magnitude reduction in sleep SBP.
KW - angiotensin II receptor blocker
KW - blood pressure
KW - calcium-channel blocker
KW - glomerular filtration rate
KW - hypertension
KW - insulin resistance
KW - nondipper
KW - oxidative stress
KW - sleep blood pressure
KW - thiazide diuretic
KW - urinary albumin excretion
UR - http://www.scopus.com/inward/record.url?scp=79952959058&partnerID=8YFLogxK
U2 - 10.1038/ajh.2010.240
DO - 10.1038/ajh.2010.240
M3 - Review article
C2 - 21164498
AN - SCOPUS:79952959058
SN - 0895-7061
VL - 24
SP - 466
EP - 473
JO - American Journal of Hypertension
JF - American Journal of Hypertension
IS - 4
ER -