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Predictors of proteinuria reduction by monotherapy with an angiotensin receptor blocker, olmesartan.

AbstractINTRODUCTION:
It is known that reduced glomerular filtration rate (GFR) is a crucial factor to limit the blood pressure lowering effect of antihypertensives. In the present study, we tested whether the effects of monotherapy with an angiotensin receptor blocker (ARB) to lower proteinuria could be restricted by reduced GFR.
MATERIALS AND METHODS:
Thirty-five renal patients who had albuminuria more than 30 mg/day, but did not have diabetic nephropathy or nephrotic syndrome, were studied before and during eight weeks of monotherapy with ARB, olmesartan.
RESULTS:
Blood pressure was lowered from 129 ± 18/79 ± 12 to 116 ± 18/72 ± 12 mmHg (p < 0.0001), while albuminuria was reduced from 614±630 to 343±472 mg/day (p < 0.0001). Albuminuria was inversely correlated with GFR both before and during treatment. Albuminuria reduction was enhanced as plasma renin activity (p = 0.047) and dose of olmesartan were increased (p = 0.04). Although the absolute reduction in proteinuria was not correlated with GFR (p = 0.56), the % reduction was significantly proportional with GFR (p = 0.027). Multiple regression analysis demonstrated that 64% of proteinuria reduction could be explained by baseline levels of albuminuria, GFR and renin activity.
CONCLUSIONS:
The reduction in proteinuria by olmesartan may be roughly predicted using baseline GFR and other parameters. These findings clarify that the effect of ARB on proteinuria reduction is restricted by reduced GFR.
AuthorsMinamo Ono, Michio Fukuda, Toshiyuki Miura, Masashi Mizuno, Yoko Kato, Ryo Sato, Takehiro Naito, Hiroyuki Togawa, Yuji Sasakawa, Tatsuya Tomonari, Tadashi Ichikawa, Yuichi Shirasawa, Akinori Ito, Atsuhiro Yoshida, Genjiro Kimura
JournalJournal of the renin-angiotensin-aldosterone system : JRAAS (J Renin Angiotensin Aldosterone Syst) Vol. 13 Issue 2 Pg. 239-43 (Jun 2012) ISSN: 1752-8976 [Electronic] England
PMID22333486 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Angiotensin Receptor Antagonists
  • Imidazoles
  • Tetrazoles
  • olmesartan
  • Renin
Topics
  • Adolescent
  • Adult
  • Aged
  • Albuminuria (blood, drug therapy, physiopathology)
  • Angiotensin Receptor Antagonists (pharmacology, therapeutic use)
  • Blood Pressure (drug effects)
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Imidazoles (pharmacology, therapeutic use)
  • Male
  • Middle Aged
  • Prognosis
  • Proteinuria (blood, drug therapy, physiopathology)
  • Renin (blood)
  • Tetrazoles (pharmacology, therapeutic use)
  • Young Adult

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