Renoprotective effect of losartan in comparison to amlodipine in patients with chronic kidney disease and hypertension - A report of the Japanese losartan therapy intended for the global renal protection in hypertensive patients (JLIGHT) study

被引:69
作者
Iino, Y
Hayashi, M
Kawamura, T
Shiigai, T
Tomino, Y
Yamada, K
Kitajima, T
Ideura, T
Koyama, A
Sugisaki, T
Suzuki, H
Umemura, S
Kawaguchi, Y
Uchida, S
Kuwahara, M
Yamazaki, T
机构
[1] Nippon Med Coll, Dept Med, Bunkyo Ku, Tokyo 1138603, Japan
[2] Nippon Med Coll, Dept Med 2, Tokyo 1138603, Japan
[3] Keio Univ, Sch Med, Dept Internal Med, Tokyo, Japan
[4] Jikei Univ, Sch Med, Dept Internal Med, Tokyo, Japan
[5] Toride Kyodo Gen Hosp, Dept Internal Med, Toride, Japan
[6] Juntendo Univ, Sch Med, Dept Internal Med, Tokyo, Japan
[7] Sakura Natl Hosp, Dept Internal Med, Sakura, Chiba, Japan
[8] Univ Tsukuba, Dept Internal Med, Tsukuba, Ibaraki, Japan
[9] Showa Univ, Fujigaoka Hosp, Div Nephrol, Yokohama, Kanagawa, Japan
[10] Showa Univ, Sch Med, Dept Nephrol, Tokyo 142, Japan
[11] Yokohama City Univ, Postgrad Sch Med, Dept Med Sci & Cardiorenal Med, Yokohama, Kanagawa, Japan
[12] Jikei Univ, Sch Med, Dept Internal Med, Tokyo, Japan
[13] Teikyo Univ, Sch Med, Dept Internal Med, Tokyo 173, Japan
[14] Tokyo Med & Dent Univ, Tokyo, Japan
[15] Univ Tokyo, Grad Sch Med, Tokyo, Japan
关键词
losartan; angiotensin; proteinuria; hypertension; renoprotection;
D O I
10.1291/hypres.27.21
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
A 12-month, multicenter (57 clinical institutions), randomized, open-labeled trial was undertaken to compare the efficacy of the angiotensin 11 receptor antagonist losartan and the calcium channel blocker amlodipine in patients with proteinuric chronic kidney disease (CKD) and hypertension. A total of 117 patients (79, chronic glomerulonephritis; 14, diabetic nephropathy; 24, other CKD) were randomly allocated into two treatment groups. Losartan and amlodipine exerted the same efficacy for blood pressure (BP) control; however, losartan significantly reduced the 24-h urinary protein excretion at months 3, 6, and 12, with the reduction of 20.7%, 35.2%, 35.8%, whereas amlodipine did not change the amount of proteinuria over the 12-month study period. When patients were stratified into groups according to the level of BP control at 3 months, the reduction in urinary protein excretion by losartan was evident in the group for which a BP of <140/90 mmHg was achieved, as well as in the group for which the goal BP (<130/85 mmHg) for treatment of CKD was not achieved. When patients were stratified according to baseline urinary protein excretion, those with greater than or equal to2g/day showed a reduction in proteinuria by losartan of 23.3%, 39.4%, and 47.9% at months 3, 6, and 12, and those with <2 g/day showed a reduction of 18.5% and 31.2% at months 3 and 6, respectively. No fatal adverse events were experienced in either drug group. We conclude that losartan reduced proteinuria in patients with CKD and hypertension. This positive effect may contribute to the renal protective benefit of losartan, and is beyond the magnitude of BP control.
引用
收藏
页码:21 / 30
页数:10
相关论文
共 27 条
[1]   Effect of ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis - A randomized controlled trial [J].
Agodoa, LY ;
Appel, L ;
Bakris, GL ;
Beck, G ;
Bourgoignie, J ;
Briggs, JP ;
Charleston, J ;
Cheek, D ;
Cleveland, W ;
Douglas, JG ;
Douglas, M ;
Dowie, D ;
Faulkner, M ;
Gabriel, A ;
Gassman, J ;
Greene, T ;
Hall, Y ;
Hebert, L ;
Hiremath, L ;
Jamerson, K ;
Johnson, CJ ;
Kopple, J ;
Kusek, J ;
Lash, J ;
Lea, J ;
Lewis, JB ;
Lipkowitz, M ;
Massry, S ;
Middleton, J ;
Miller, ER ;
Norris, K ;
O'Connor, D ;
Ojo, A ;
Phillips, RA ;
Pogue, V ;
Rahman, M ;
Randall, OS ;
Rostand, S ;
Schulman, G ;
Smith, W ;
Thornley-Brown, D ;
Tisher, CC ;
Toto, RD ;
Wright, JT ;
Xu, SC .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 285 (21) :2719-2728
[2]   Renoprotective effects of angiotensin II receptor blockade in type 1 diabetic patients with diabetic nephropathy [J].
Andersen, S ;
Tarnow, L ;
Rossing, P ;
Hansen, BV ;
Parving, HH .
KIDNEY INTERNATIONAL, 2000, 57 (02) :601-606
[3]  
Aros C, 2002, J HYPERTENS, V20, pS45
[4]   Nifedipine and enalapril equally reduce the progression of nephropathy in hypertensive type 2 diabetics [J].
Baba, S .
DIABETES RESEARCH AND CLINICAL PRACTICE, 2001, 54 (03) :191-201
[5]  
Black HR, 1997, ARCH INTERN MED, V157, P2413
[6]   Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy [J].
Brenner, BM ;
Cooper, ME ;
de Zeeuw, D ;
Keane, WF ;
Mitch, WE ;
Parving, HH ;
Remuzzi, G ;
Snapinn, SM ;
Zhang, ZX ;
Shahinfar, S .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 345 (12) :861-869
[7]  
Burnier M, 1999, J AM SOC NEPHROL, V10, pS278
[8]   Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure [J].
Chobanian, AV ;
Bakris, GL ;
Black, HR ;
Cushman, WC ;
Green, LA ;
Izzo, JL ;
Jones, DW ;
Materson, BJ ;
Oparil, S ;
Wright, JT ;
Roccella, EJ .
HYPERTENSION, 2003, 42 (06) :1206-1252
[9]  
de Boer E, 1999, KIDNEY INT, V56, pS42
[10]  
Fassbinder W, 1999, INT J CLIN PRACT, V53, P519