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Beneficial effect of verapamil added to chronic ACE inhibitor treatment on renal function in hypertensive elderly patients

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Abstract

This study analysed the effect of low doses ofverapamil added to chronic treatment withangiotensin-converting enzyme (ACE) inhibitors onblood pressure and serum creatinine levels in eightelderly hypertensive patients who had a steadyincrease of serum creatinine while on ACE inhibitors.The study was performed in eight elderly hypertensivesubjects, five men and three women (mean age 70 ±2 years; systolic blood pressure 173 ± 4 mmHg; diastolic blood pressure 99 ± 1 mm Hg) andserum creatinine of 1.60 ± 0.27 mg/dl beforetreatment. During an average of 25 weeks, ACEinhibitors significantly reduced both systolic anddiastolic blood pressures, but serum creatinine levelswere increased over basal levels (0,68 ± 0,20 mg/dl, p < 0.05). During an average of 10 weeks,the addition of verapamil did not decrease bloodpressure further, but serum creatinine levels werereduced to baseline. Our study suggests that theaddition of verapamil to ACE inhibitors can reverseACE-induced increase in creatinine levels in elderlyhypertensive patients in whom this side effect isobserved.

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References

  1. Materson BJ, Reda DJ, Preston RA, Cushman WC, Massie BM, Freis ED, Kochar MS, Hamburger RJ, Fye C, Lakshman R, Gottdiener J, Ramirez EA, Henderson WG, for the Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. Response to a second single antihypertensive agent used as monotherapy for hypertension after failure of the initial drug. Arch Intern Med 1995; 155: 1757–1762.

    Article  PubMed  CAS  Google Scholar 

  2. Materson BJ, Reda DJ, Cushman WC, Massie BM, Freis ED, Kochar MS, Hamburger RJ, Fye C, Lakshman R, Gottdiener J, Ramirez EA, Henderson WG, for the Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. Single-drug therapy for hypertension in men: A comparison of six antihypertensive agents with placebo. N Engl J Med 1993; 328: 914–921.

    Article  PubMed  CAS  Google Scholar 

  3. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265: 3255–3264.

    Article  Google Scholar 

  4. MRC Working Party: Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ 1992; 304: 405–412.

    Article  Google Scholar 

  5. Dahlöf B, Lindholm LH, Hansson L, Scherstén B, Ekbom T, Wester P-O. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991; 338: 1281–1285.

    Article  PubMed  Google Scholar 

  6. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhäger WH, Bulpitt CJ, de Leeuw PW, Dollery CT, Fletcher AE, Forette F, Leonetti G, Nachev C, O'Brien ET, Rosenfeld J, Rodicio JL, Tuomilehto J, Zanchetti A, for the Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997; 350: 757–764.

    Article  PubMed  CAS  Google Scholar 

  7. Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure and the National High Blood Pressure Education Program Coordinating Committee. The 6th report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Arch Intern Med 1997; 157: 2413–2446.

    Article  Google Scholar 

  8. Kendall MJ. Hypertension in the elderly. Basic Res Cardiol 1998; 93(suppl 2): 43–46.

    PubMed  Google Scholar 

  9. González-Albarrán O, García Robles R, Ruilope LM. Therapeutic implications and new perspectives for essential hypertension and renal damage. Kidney Int 1998; 54(suppl 68): S-46–S-50.

    Google Scholar 

  10. Williams GW. Converting-enzyme inhibitors in the treatment of hypertension. N Engl J Med 1988; 319: 1517–1525.

    Article  PubMed  CAS  Google Scholar 

  11. Brands MW, Granger JP. Control of renal function and blood pressure by angiotensin II: implications for diabetic glomerular injury. Miner Electrolyte Metab 1998; 24: 371–380.

    Article  PubMed  CAS  Google Scholar 

  12. Ravid M, Lang R, Rachmani R, Lishner M. Long-term renoprotective effect of angiotensin-converting enzyme inhibition in non-insulin-dependent diabetes mellitus. A 7 year follow-up study. Arch Intern Med 1996; 156: 286–289.

    Article  PubMed  CAS  Google Scholar 

  13. Maschio G, Alberti D, Janin G, Locatelli F, Mann JFE, Motolese M, Ponticelli C, Ritz E, Zuchelli P, for the Angiotensin-Converting-Enzyme Inhibition in Progressive Renal Insufficiency Study Group. Effect of the angiotensinconverting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. N Engl JMed 1996; 334: 939–945.

    Article  CAS  Google Scholar 

  14. Gotloib L, Jaichenko S, Fudin R, Shostok A. Severe reduction of renal function in hypertensive and/or diabetics induced by angiotensin-converting enzyme inhibitors. Nephron 1995; 71: 230–231.

    PubMed  CAS  Google Scholar 

  15. Toto R, Mitchell H, Lee H, Milan C, Pettinger W. Reversible renal insufficiency due to angiotensin converting enzyme inhibitors in hypertensive nephrosclerosis. Ann Intern Med 1991; 115: 513–519.

    PubMed  CAS  Google Scholar 

  16. Toto RD. Renal insufficiency due to angiotensin-converting enzyme inhibitors. Miner Electrolyte Metab 1994; 20: 193–200.

    PubMed  CAS  Google Scholar 

  17. Wei JY. Use of calcium entry blockers in elderly patients. Special considerations. Circulation 1989; 80(suppl IV): IV-171–IV-177.

    CAS  Google Scholar 

  18. Buhler FR, Kowski W. Age and antihypertensive response to calcium antagonists. J Hypertens (suppl) 1987; 5: S111–S114.

    CAS  Google Scholar 

  19. Yang Z, Noll G, Lüscher TF. Calcium antagonists differently inhibit proliferation of human coronary smooth muscle cells in response to pulsatile strech and platelet-derived growth factor. Circulation 1993; 88: 832–836.

    PubMed  CAS  Google Scholar 

  20. Ruschitzka FT, Lüscher TF. Concept for a combination of ACE inhibitors and calcium antagonists in cardiovascular disease. J Cardiovasc Pharmacol 1997; 30(suppl 1): S10–S23.

    Google Scholar 

  21. Bitar R, Martín B, López-Novoa JM, Macías-Núnez JF. Reduction of renal function by angiotensin-converting enzyme inhibitors: effect of verapamil. Nephron 1997; 75: 486–487.

    PubMed  CAS  Google Scholar 

  22. Bonsnes RW, Tausski HA. The colorimetric determination of creatinine of the Jaffé reaction. J Biol Chem 1945; 158: 581–583.

    CAS  Google Scholar 

  23. Müller FB, Bolli P, Linder L, Kiowski W, Erne P, Bühler FR. Calcium antagonists and the second drug for hypertensive therapy. Am J Med 1986; 81(suppl 6A): 25–29.

    Article  PubMed  Google Scholar 

  24. Bakris GL; Weir MR; DE Quatro V, McMahon FG. Effect of an ACE inhibitor/calcium antagonist combination on proteinuria in diabetic nephropathy. Kidney Int 1998; 54: 1283–1289.

    Article  PubMed  CAS  Google Scholar 

  25. Li JS, Schiffrin EL. Effect of calcium channel blockade or angiotensin converting enzyme inhibition on structure of coronary, renal, and other small arteries in spontaneously hypertensive rats. J Cardiovasc Pharmacol 1996; 28: 68–74.

    Article  PubMed  CAS  Google Scholar 

  26. Gallego B, Flores O, López-Novoa JM, Pérez-Barricanal F. Renal effects of antihypertensive therapy in uninephrectomized diabetic rats. Res Exp Med 1997; 197: 199–209.

    Article  CAS  Google Scholar 

  27. Flores O, Arévalo M, Gallego B, Hidalgo F, Vidal S, López-Novoa JM. Beneficial effect of the long-term treatment with the combination of an ACE inhibitor and a calcium channel blocker on renal injury in rats with 5/6 nephrectomy. Exp Nephrol 1998; 6: 39–49.

    Article  PubMed  CAS  Google Scholar 

  28. Laurence DR, Bennett PN, Brown MJ editors. Clinical Pharmacology. New York: Churchill Livinstone, 1997, pp. 428–432.

    Google Scholar 

  29. Tschudi MR, Noll G, Wenzel RR, Lüscher TF. Calcium antagonists and endothelial function: interaction with nitric oxide and endothelin. J Cardiovasc Pharmacol 1997; 30(suppl 3): S9–S17.

    Google Scholar 

  30. Bagate K, Develioglu L, Michel B, Grima M, Imbs JL, Bartheimebs M. Réponses vaculaires rénales de la bradykinine sur le rein isolé de rat. Arch Mal Coeur 1997; 90: 1131–1134.

    PubMed  CAS  Google Scholar 

  31. Rodríguez-Barbero A, Martínez-Salgado C, Pérez-Barriocanal F, López-Novoa JM, Macías-Núñez JF. Perindopril stimulates cultured mesangial cell activation via bradykinin accumulation. Cell Physiol Biochem 1997; 7: 69–80.

    Google Scholar 

  32. Abbott KC, Bakris G. Renal effects of antihypertensive medications: An overview. J Clin Pharmacol 1993; 33: 392–399.

    PubMed  CAS  Google Scholar 

  33. Montero A, González-Sarmiento R, Rodríguez-López AM, López-Novoa JM. Effect of verapamil on endothelium-1 induced proliferation in cultured rat mesangiall cells. Cell Physiol Biochem 1995; 5: 155–166.

    Article  CAS  Google Scholar 

  34. Harris JP, DCH, Chan L, Schrier RW. Remnant kidney hypermetabolism and progression of chronic renal failure. Am J Physiol 1988; 254: F267–F276.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Instituto Reina Sofía de Investigación Nefrológica and Departamento de Fisiología y Farmacología, Universidad de Salamanca, Spain

    Reda Bitar, Olga Flores, María Reverte, José Miguel López-Novoa & Juan Florencio Macías

  2. Departamento de Medicina, Servicio de Nefrología, Hospital Clínico Universitario, Universidad de Salamanca, Paseo de San Vicente s/n, 37007, Salamanca, Spain

    Juan Florencio Macías

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  1. Reda Bitar
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  2. Olga Flores
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  4. José Miguel López-Novoa
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  5. Juan Florencio Macías
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Bitar, R., Flores, O., Reverte, M. et al. Beneficial effect of verapamil added to chronic ACE inhibitor treatment on renal function in hypertensive elderly patients. Int Urol Nephrol 32, 165–169 (2000). https://doi.org/10.1023/A:1007123725297

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