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Effects of an ACE inhibitor combined with a calcium channel blocker on progression of diabetic nephropathy.

Abstract
It is clear that angiotensin-converting enzyme (ACE) inhibitors slow progression of diabetic nephropathy to a greater extent than other antihypertensive agents when blood pressure (BP) is reduced to levels below 140/90 mm Hg. Recent studies also demonstrate that nondihydropyridine calcium channel blockers (NDCCBs) slow progression of diabetic nephropathy in people with pre-existing renal insufficiency secondary to non-insulin dependent diabetes mellitus. The combined effects of both a CCB and ACE inhibitor have recently been examined in both animal models of diabetes as well as patients with established diabetic nephropathy. These studies demonstrate the following points: (a) at comparable BP levels, a combination of an ACE inhibitor with a NDCCB result in a greater reduction in proteinuria when compared to either components alone; and (b) conversely, addition of an ACE inhibitor to a dihydropyridine CCB (DCCB) yields effects on proteinuria similar to the ACE inhibitor alone. Therefore, addition of an ACE inhibitor to a DCCB demonstrates protection against the effects of DCCB alone. Addition of an ACE inhibitor to a NDCCB does not potentiate the preservation of renal morphology associated with progression of diabetic nephropathy when compared to either of its components alone. Conversely, a DCCB/ACE inhibitor combination yields morphologic results similar to the ACE inhibitor alone. Taken together these results suggest that ACE inhibitors when combined with a NDCCB result in greater reductions in proteinuria, and similar preservation of renal morphology when compared to either of its components alone.
AuthorsG Bakris, D White
JournalJournal of human hypertension (J Hum Hypertens) Vol. 11 Issue 1 Pg. 35-8 (Jan 1997) ISSN: 0950-9240 [Print] England
PMID9111155 (Publication Type: Journal Article, Review)
Chemical References
  • Angiotensin-Converting Enzyme Inhibitors
  • Calcium Channel Blockers
Topics
  • Angiotensin-Converting Enzyme Inhibitors (pharmacology, therapeutic use)
  • Animals
  • Calcium Channel Blockers (pharmacology, therapeutic use)
  • Diabetic Nephropathies (drug therapy)
  • Disease Progression
  • Drug Therapy, Combination
  • Humans

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