Effects of dihydropyridine calcium channel blockers, angiotensin-converting enzyme inhibition, and blood pressure control on chronic, nondiabetic nephropathies. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN).

摘要: Dihydropyridine-type calcium channel blockers (dihydropyridine CCB) adversely affect renal function in diabetes. The effects of dihydropyridine CCB on 24-h urinary protein excretion rate and GFR decline (deltaGFR) were prospectively evaluated 117 nondiabetic patients with chronic, proteinuric nephropathies enrolled the Ramipril Efficacy Nephropathy study randomized to angiotensin-converting enzyme inhibition (ACEI) or placebo plus conventional antihypertensive therapy. Sixty-three percent treated CCB. During follow-up, CCB-treated compared no had higher proteinuria (mean+/-SEM: 4.8+/-0.2 g/24 h versus 4.2+/-0.2 h, respectively, P = 0.015) mean arterial BP (MAP). difference was significant group (5.1+/-0.2 4.3+/-0.3 0.02), but not ACEI (4.4+/-0.2 4.1+/-0.2 h). Of note, significantly less (P 0.028) placebo. a faster deltaGFR overall population group, group. Proteinuria comparable CCBtreated for MAP 100 mmHg. Similarly, In CCB- placebo-treated patients, linear correlation 0.006 both groups) found between values. MAP, proteinuria, given nifedipine those other comparable. Thus, nephropathies, may have an adverse effect handling that depends severity hypertension is minimized by therapy tight control. ACE inhibitors electively limit treatment and/or uncontrolled hypertension.