Skip to main content
Log in

Antiproteinuric effects of antihypertensive agents in non-diabetic hypertensive population

  • Research Article
  • Published:
Central European Journal of Medicine

Abstract

Arterial hypertension and proteinuria are important factors associated with the progression of both diabetic and nondiabetic chronic kidney disease. The objective of the present study was to determine the influence of different antihypertensive drug groups on urinary albumin excretion (UAE) as related to blood pressure in non-diabetic population. Subjects (n=39) with chronic renal disease accompanied by mild to moderate hypertension and varying degrees of proteinuria were divided into 3 groups based on UAE values and placed on nonpharmacological and/or treatment with an antihypertensive drug regimen (consisting of one or more antihypertensive drugs [beta blocker, ACE inhibitor or calcium-channel blocker]) to achieve a target blood pressure ≤ 130/85 mmHg. Periodic UAE measurements were performed. A reduction was observed over time in most patients, however, it reached statistical significance only in the microalbuminuric group (P<0.01). Patients were further stratified into 5 groups depending on assigned therapy: 0, nonpharmacological treatment; 1-drug group 1; 12-drug groups 1 and 2; 13-drug groups 1 and 3; 123-all 3 drug groups (1-ACE inhibitors, 2-beta blockers, 3-calcium channel blockers). A statistically significant change in mean UAE values at the start and end of the study period in patients assigned to drug groups 12, 13, and 123 was achieved (P < 0.05). Also, there was a statistically significant difference in the average reduction of proteinuria under varying antihypertensive drug regimens (P < 0.05). In conclusion, in patients with hypertension, changes in UAE depend on initial UAE values and administered antihypertensive treatment. ACE inhibitors combined with calcium channel blockers resulted in a higher UAE reduction than other drug groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Wenzel RR., Renal protection in hypertensive patients: selection of antihypertensive therapy, Drugs, 2005, 65 Suppl 2, 29–39

    Article  PubMed  CAS  Google Scholar 

  2. Wolf S. and Risler T., Are all antihypertensive drugs renoprotective?, Herz, 2004, 29(3), 248–254 (in German)

    Article  PubMed  Google Scholar 

  3. Viberti G.C., Hill R.D., Jarrett R.J., Argyropoulos A., Mahmud U., Keen H., Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus, Lancet, 1982, 1, 1430–1432

    Article  PubMed  CAS  Google Scholar 

  4. Peterson J.C., Adler S., Burkart J.M., Greene T., Herbert L.A., Hunsicker L.G., et al., Blood pressure control, proteinuria, and the progression of renal disease, The Modification of Diet in Renal Disease Study, Ann. Intern. Med.,1995, 123, 754–762

    PubMed  CAS  Google Scholar 

  5. Tanaka H., Hayashi M., Date C., Imai K., Asada M., Shoji H., et al., Epidemiologic studies of stroke in Shibata, a Japanese provincial city: Preliminary report on risk factors for cerebral infarction, Stroke, 1985, 16, 773–780

    PubMed  CAS  Google Scholar 

  6. Yudkin J.S., Forrest R.D., Jackson C., Microalbuminuria as predictor of vascular disease in non-diabetic subjects: Islington Diabetes Survey, Lancet, 1988, 2, 530–533

    Article  PubMed  CAS  Google Scholar 

  7. Haffner S.M., Stern M.P., Gruber M.K., Hazuda H.P., Mitchell B.D., Patterson J.K., Microalbuminuria: Potential marker for increased cardiovascular risk factors in nondiabetic subjects?, Arteriosclerosis, 1990, 10, 727–731

    PubMed  CAS  Google Scholar 

  8. Samuelsson O., Hypertension in middle-aged men: Management, morbidity and prognostic factors during long-term hypertensivecare, Acta Med. Scand. Suppl., 1985, 702, l–79

    Google Scholar 

  9. Mogensen C.E., Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes, N. Engl. J. Med., 1984, 310, 356–360

    PubMed  CAS  Google Scholar 

  10. Gerstein H.C., Mann J.F., Yi Q., Zinman B., Dinneen S.F., Hoogwerf B., et al., Albuminuria and risk ofcardiovascular events, death, and heart failure in diabetic and nondiabetic individuals, JAMA, 2001, 286, 421–426

    Article  PubMed  CAS  Google Scholar 

  11. Hillege H.L., Fidler V., Diercks G.F., van Gilst W.H., de Zeeuw D., van Veldhuisen D.J., et al., Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population, Circulation, 2002, 106, 1777–1782

    Article  PubMed  CAS  Google Scholar 

  12. Redon J., Renal protection by antihypertensive drugs: insights from microalbuminuria studies, J. Hypertens., 1998, 16, 2091–2100

    Article  PubMed  CAS  Google Scholar 

  13. Maki D.D., Ma J.Z., Louis T.A., Kasiske B.L., Long-term effects of antihypetensive agents on proteinuria and renal function, Arch. Intern. Med., 1995, 155, 1073–1080

    Article  PubMed  CAS  Google Scholar 

  14. Gansevoort R.T., Sluiter W.J., Hemmelder M.H., de Zeeuw D., de Jong P.E., Antiproteinuric effect of blood-pressure-lowering agents: a meta-analysis of comparative trials, Nephrol. Dial. Transplant., 1995, 10, 1963–1974

    PubMed  CAS  Google Scholar 

  15. Giatras I., Lau J., Levey A.S., Effect of angiotensinconverting enzyme inhibitors on the progression of non-diabetic renal disease: a meta-analysis of randomized trials. Angiotensin-Converting Enzyme Inhibition and Progressive Renal Disease Study Group, Ann. Intern. Med., 1997, 127, 337–345

    PubMed  CAS  Google Scholar 

  16. Preston R.A., Renoprotective effects of antihypertensive drugs, Am. J. Hypertens., 1999, 12, 19S–32S

    Article  PubMed  CAS  Google Scholar 

  17. Erley C.M., Haefele U., Heyne N., Braun N., Risler T., Microalbuminuria in essential hypertension, Reduction by different antihypertensive drugs, Hypertension, 1993, 21, 810–815

    PubMed  CAS  Google Scholar 

  18. Himmelmann A., Hansson L., Hansson B.G., Hedstrand H., Skogstrom K., Ohrvik J., et al., ACE inhibition preserves renal function better than beta blockade in the treatment of essential hypertension, Blood Press., 1995, 4, 85–90

    Article  PubMed  CAS  Google Scholar 

  19. Manjunath G., Sarnak M.J., Levey A.S., Prediction equations to estimate glomerular filtration rate: An update, Curr. Opin. Nephrol. Hypertens., 2001, 10, 785–792

    Article  PubMed  CAS  Google Scholar 

  20. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia), Randomised placebocontrolled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy, Lancet, 1997, 349, 1857–1863

    Article  Google Scholar 

  21. Lewis E.J., Hunsicker L.G., Bain R.P., Rohde R.D., The effect of angiotensin-convertingenzyme inhibition on diabetic nephropathy, The Collaborative Study Group, N. Engl. J. Med., 1993, 329, 1456–1462

    Article  PubMed  CAS  Google Scholar 

  22. Salvetti A., Mattei P., Sudano I., Renal protection and antihypertensive drugs: current status, Drugs, 1999, 57, 665–693

    Article  PubMed  CAS  Google Scholar 

  23. Cirillo M. and De Santo N.G., Microalbuminuria in nondiabetic adults, G. Ital. Nefrol., 2002, 19, 273–277

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Karin Vasic.

About this article

Cite this article

Jovic, Z., Djordjevic, V., Vasic, K. et al. Antiproteinuric effects of antihypertensive agents in non-diabetic hypertensive population. cent.eur.j.med 3, 287–293 (2008). https://doi.org/10.2478/s11536-008-0036-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2478/s11536-008-0036-8

Keywords

Navigation