Urinary albumin excretion during angiotensin II receptor blockade: Comparison of combination treatment with a diuretic or a calcium-channel blocker

Yoshio Matsui, Kazuo Eguchi, Joji Ishikawa, Kazuyuki Shimada, Kazuomi Kario

Research output: Contribution to journalReview articlepeer-review

22 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)466-473
Number of pages8
JournalAmerican Journal of Hypertension
Volume24
Issue number4
DOIs
StatePublished - Apr 2011
Externally publishedYes

Keywords

  • angiotensin II receptor blocker
  • blood pressure
  • calcium-channel blocker
  • glomerular filtration rate
  • hypertension
  • insulin resistance
  • nondipper
  • oxidative stress
  • sleep blood pressure
  • thiazide diuretic
  • urinary albumin excretion

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