Medicine - Xagena

A study assessed if adding Candesartan ( Atacand ) to ACE ( angiotensin-converting enzyme ) inhibitors would delay progression of nephropathy in hypertensive patient with non-diabetic renal disease.

Candesartan cilexetil is an angiotensin II receptor antagonist ( ARB ).

The study involved 90 hypertensive patients with chronic renal insufficiency, who had urinary protein excretion exceeding 1.0g/d despite treatment with ACE inhibitors.
They were randomised to ACE inhibitor, either Benazepril ( Lotensin ) 2.5 to 10 mg daily or Trandolapril ( Mavik ) 2 to 4 mg daily, plus Candesartan ( 2 to 12 mg/d ), or to control group ( ACE inhibitors only ).

The target blood pressure was 130/80 mmHg or less and the primary outcome was the changes in serum creatinine and the reduction of proteinuria.

The mean duration of follow-up was 3.1 years.

At years 2 and 3, systolic and diastolic blood pressure were reduced from 140/84 to 129/78 mmHg in the Candesartan group and from 135/85 to 130/80 mmHg in the control group ( p < 0.01 from baseline in both groups ).

Serum creatinine increased from 3.02 to 3.38 mg/dl ( 267-299 micromol/L ) in the Candesartan group versus 3.00 to 4.48 mg/dl ( 265-396 micromol/L ) in the ACE inhibitor group ( p < 0.01 at year 3 in ACE inhibitor group ).

The level of proteinuria declined in each group ( p < 0.05 ), the degree of reduction was greater in the Candesartan than in the control group ( p < 0.01 ).

Pretreatment proteinuria correlated significantly with decline of renal function in both groups, whereas reduction of proteinuria negatively correlated with decline in renal function in the Candesartan group.

The authors conclude “ Candesartan plus an ACE inhibitor was effective in slowing the progression of renal insufficiency in hypertensive patients with non-diabetic renal disease through reduction of proteinuria.”

Source: Clinical Journal of the American Society of Nephrology, 2006


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