Japan-Indonesia Collaborative Study of Imidapril on Antipro-teinuria Effect in Hypertensive Patients with Chronic kidney Disease

Rumah Ginjal - Abstract

Background:Chronic kidney disease(CKD)is a comprehensive disease concept that includes chronic glomerulonephritis such as IgA nephropathy or lupus nephritis, diabetic nephropathy and hypertensive nephrosclerosis. CKD is a risk factor for end stage kidney disease(ESKD)and cardiovascular diseases(CVD). It is considered that angiotensin─converting enzyme(ACE)inhibitors and angiotensin II receptor blockers(ARBs)induce a marked renoprotective effect in patients with CKD. The purpose of the present Japan─Indonesia collaborative study was to evaluate the antiproteinuric effect of imidapril, one of the ACEIs, in hypertensive patients with CKD.  Methods:Twenty three hypertensive CKD patients were treated with imidapril and a calcium channel blocker(CCB). Imidapril was added for patients who had been treated with a CCB such as diltiazem at the start of this study. When blood pressure(BP)did not reach the target level(<130/85 mmHg), imidapril dosage was increased to 10 mg/day and administered for 12 months. Alternatively, patients were treated with 5─10 mg/day of imidapril.  Results:In the imidapril + CCB combination therapy, systolic blood pressure(SBP)and diastolic blood pressure( DBP) were significantly reduced, both at 6 months and at the end of the clinical study. Only DBP reached values below the target level. Urinary albumin excretion (UAE)levels were markedly decreased at 6 and 12 months when compared with the baseline values(0.45 ± 0.54g/g・Cr indicating typical overt proteinuria) and these decreases at both time points were significant. The UAE levels at both 6 and 12 months complied with the diagnostic criteria for microalbuminuria(< 0.299 g/g・Cr).  Conclusion:In this collaborative study, a combination of imidapril and a CCB, such as diltiazem, significantly reduced BP, and reduced UAE, suggesting strict BP control may induce an efficient decrease in UAE. It appears that imidapril─based therapy has renoprotective effects in hypertensive patients with CKD.

Source: https://www.jstage.jst.go.jp/article/pjmj/56/2/56_100/_article/-char/en

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