Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients

被引:157
作者
Velussi, M
Brocco, E
Frigato, F
Zolli, M
Muollo, B
Maioli, M
Carraro, A
Tonolo, G
Fresu, P
Cernigoi, AM
Fioretto, P
Nosadini, R
机构
[1] UNIV PADUA,IST MED INTERNA,POLICLIN,I-35128 PADUA,ITALY
[2] CTR ANTIDIABET MONFALCONE,MONFALCONE,GORIZIA,ITALY
[3] CTR ANTIDIABET MESTRE,MESTRE,ITALY
[4] CTR ANTIDIABET MIRANO,MIRANO,VENEZIA,ITALY
[5] CTR ANTIDIABET ESTE,ESTE,ITALY
[6] UNIV SASSARI,IST CLIN MED,I-07100 SASSARI,ITALY
关键词
D O I
10.2337/diabetes.45.2.216
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Contrasting information has been reported concerning the course of renal function in NIDDM with hypertension alone or in association with renal damage. The aim of the present study was to elucidate the course of the glomerular filtration rate (GFR) in hypertensive NIDDM patients during antihypertensive therapy. Furthermore, we compared the effects of ACE inhibitors (cilazapril, Inibace, Roche, Milan, Italy) and Ca2+-channel blockers (amlodipine, Norvasc, Pfizer, home, Italy). Of the hypertensive NIDDM patients attending the outpatient's clinic of the internal medicine departments of the University of Padova and Sassari, 44 participated in the present study. Of these patients, 26 were normoalbuminuric and 18 microalbuminuric. They were randomly treated with either cilazapril or amlodipine. The target of antihypertensive treatment was a value < 140 mmHg for systolic and 85 mmHg for diastolic blood pressure (BP). Microalbuminuria was defined as an albumin excretion rate (AER) between 20 and 200 mu g/min. GFR was measured by plasma clearance of Cr-51-labeled EDTA at baseline and every 6-12 months during a 3-year follow-up interval. A significant decrease was observed in the values of GFR, AER, and systolic and diastolic BP in normoalbuminuric and microalbuminuric patients during antihypertensive therapy. The GFR fall in the overall population of NIDDM patients was significantly and inversely related to the decrease of mean BP (diastolic + 1/3 pulse pressure) (r = -0.80, P < 0.0001) but not to that of HbA(1c) triglycerides, and BMI. The GFR decline (mean +/- SE) per year in the normoalbuminuric patient was 2.03 +/- 0.66 ml . min(-1). 1.73 m(-2) (95% CI 0.92-3.17) during cilazapril and 2.01 +/- 0.71 ml . min(-1). 1.73 m(-2) (95% CI 0.82-3.11) during amlodipine therapy. The GFR decline per year in the microalbuminuric patient was 2.15 +/- 0.69 ml . min(-1). 1.73 m(-2) (95% CI 0.86-3.89) during cilazapril and 2.33 +/- 0.83 ml . min(-1). 1.73 m(-2) per year (95% CI 1.03-3.67) during amlodipine therapy. Cilazapril and amlodipine lowered AER to a similar extent in normoalbuminuric and microalbuminuric patients. No significant changes were observed concerning other clinical and biochemical features between the two antihypertensive therapies and particularly HbA(1c), BMI, triglycerides, and cholesterol plasma values. These results support the tenet that arterial hypertension plays a pivotal role in contributing to renal damage in NIDDM, even when AER is normal. However, the degree of BP control, with both cilazapril and amlodipine, can successfully delay the slope of GFR decline in hypertensive NIDDM patients with or without incipient nephropathy.
引用
收藏
页码:216 / 222
页数:7
相关论文
共 38 条
[1]   TREATMENT OF ARTERIAL-HYPERTENSION IN DIABETIC HUMANS - IMPORTANCE OF THERAPEUTIC SELECTION [J].
BAKRIS, GL ;
BARNHILL, BW ;
SADLER, R .
KIDNEY INTERNATIONAL, 1992, 41 (04) :912-919
[2]  
CAREY RN, 1974, CLIN CHEM, V20, P595
[3]   COMPARISON OF ENALAPRIL AND NIFEDIPINE IN TREATING NON-INSULIN-DEPENDENT DIABETES ASSOCIATED WITH HYPERTENSION - ONE YEAR ANALYSIS [J].
CHAN, JCN ;
COCKRAM, CS ;
NICHOLLS, MG ;
CHEUNG, CK ;
SWAMINATHAN, R .
BRITISH MEDICAL JOURNAL, 1992, 305 (6860) :981-985
[4]   PREDICTION OF CREATININE CLEARANCE FROM SERUM CREATININE [J].
COCKCROFT, DW ;
GAULT, MH .
NEPHRON, 1976, 16 (01) :31-41
[5]   FURTHER DEVELOPMENT AND AUTOMATION OF A HIGH-PRESSURE LIQUID-CHROMATOGRAPHY METHOD FOR THE DETERMINATION OF GLYCOSYLATED HEMOGLOBINS [J].
DUNN, PJ ;
COLE, RA ;
SOELDNER, JS .
METABOLISM-CLINICAL AND EXPERIMENTAL, 1979, 28 (07) :777-779
[6]  
FIORETTO P, 1965, DIABETOLOGIA, V38, pA217
[7]  
FIORETTO P, 1992, AM J HYPERTENS, V5, P890
[8]   EVOLUTION OF GLOMERULAR-FILTRATION RATE IN PROTEINURIC NIDDM PATIENTS [J].
FRIEDMAN, R ;
GROSS, JL .
DIABETES CARE, 1991, 14 (05) :355-359
[9]   THE COURSE OF KIDNEY-FUNCTION IN TYPE-2 (NON-INSULIN-DEPENDENT) DIABETIC-PATIENTS WITH DIABETIC NEPHROPATHY [J].
GALL, MA ;
NIELSEN, FS ;
SMIDT, UM ;
PARVING, HH .
DIABETOLOGIA, 1993, 36 (10) :1071-1078
[10]   EFFECT OF ANTIHYPERTENSIVE THERAPY ON THE KIDNEY IN PATIENTS WITH DIABETES - A METAREGRESSION ANALYSIS [J].
KASISKE, BL ;
KALIL, RSN ;
MA, JZ ;
LIAO, MJ ;
KEANE, WF .
ANNALS OF INTERNAL MEDICINE, 1993, 118 (02) :129-138