Effects of up-titration of candesartan versus candesartan plus amlodipine on kidney function in type 2 diabetic patients with albuminuria.

Abstract

In the present study, we tested the hypothesis that up-titrating the dose of an angiotensin receptor blocker (ARB) is superior to combined treatment with an ARB and a calcium channel blocker for the same degree of blood pressure (BP) reduction, with respect to urinary albumin excretion in diabetic patients treated with a standard dose of the ARB. Hypertensive patients with type 2 diabetes mellitus and albuminuria (≥30 mg g(-1) creatinine) were enroled in the study, and were either started on or switched to candesartan (8 mg per day) monotherapy. After a 12-week run-in period, baseline evaluations were performed and patients with BP ≥130/80 mm Hg were randomly assigned to receive either candesartan (12 mg per day) or candesartan (8 mg per day) plus amlodipine (2.5 mg per day) for a further 12 weeks. The primary end-point was a reduction in urinary albumin levels. Although there was no significant difference in the BP reduction between the two groups, the reduction in urinary albumin was greater in the up-titrated than the combination therapy group (-40±14% vs -9±38%, respectively; P<0.0001). Thus, up-titration of candesartan more effectively reduces urinary albumin excretion than combined candesartan plus amlodipine in hypertensive patients with diabetes for the same degree of BP reduction.

• Authors: T Okura, M Kojima, H Machida, M Sugiyama, T Kato, T Komada, T Miyazaki, T Ninomiya, T Ichikawa, K Nakatani, Y Watanabe, Y Dohi, M Ito, G Kimura
• Journal: Journal of human hypertension (J Hum Hypertens) Vol. 26 Issue 4 Pg. 214-9 (Apr 2012) ISSN: 1476-5527 [Electronic] England
• PMID: 21412266 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Angiotensin Receptor Antagonists
• Antihypertensive Agents
• Benzimidazoles
• Biphenyl Compounds
• Calcium Channel Blockers
• Tetrazoles
• Amlodipine
• candesartan

Topics

• Aged
• Albuminuria (epidemiology, physiopathology)
• Amlodipine (pharmacology, therapeutic use)
• Angiotensin Receptor Antagonists (pharmacology, therapeutic use)
• Antihypertensive Agents (pharmacology, therapeutic use)
• Benzimidazoles (pharmacology, therapeutic use)
• Biphenyl Compounds
• Blood Pressure (drug effects, physiology)
• Calcium Channel Blockers (pharmacology, therapeutic use)
• Comorbidity
• Diabetes Mellitus, Type 2 (epidemiology, physiopathology)
• Drug Therapy, Combination
• Female
• Humans
• Hypertension (drug therapy, epidemiology, physiopathology)
• Kidney (drug effects, physiopathology)
• Male
• Middle Aged
• Prospective Studies
• Single-Blind Method
• Tetrazoles (pharmacology, therapeutic use)
• Treatment Outcome