Dissociation between blood pressure reduction and fall in proteinuria in primary renal disease: A randomized double-blind trial

Luis M. Ruilope, R. Fernández, J. C. Rodríguez-Pérez, S. García de Vinuesa, J. Garrido, R. Romero, D. Jarillo, L. Raij, I. Alvarez-Cantalapiedra, Ma R. Lázaro de Mercado, F. Gómez Campderá, D. Jarillo Ibáñez, F. García Martín, J. Mora-Maciá, J. Nieto, C. Vozmediano, L. Hortal, C. Plaza, P. Aljama, J. M. Gómez-CarrascoS. Soriano, A. Pérez-García, L. Garcés, J. Segura, J. Bonet, A. Vigil-Medina, P. Gallar, A. Oliet, C. Bernis, D. Sánz-Guajardo

Research output: Contribution to journalArticle

44 Scopus citations

Abstract

Objective: Guidelines recommend lower threshold and goal blood pressure (BP) for patients with proteinuria. BP reduction could be accompanied by a different fall in proteinuria depending of the antihypertensive drug. The objective was to compare proteinuria reduction when BP is lowered to the same level with different drugs. Design: Prospective, randomized, double-blind, controlled trial. Setting: 12 Spanish centres. Patients: A total of 119 patients with primary renal disease, blood pressure > 130/85 mmHg, proteinuria > 1 g/day, and creatinine clearance ≥ 50 ml/min. Intervention: After a 4-week run-in placebo period, patients were randomized to: atenolol 50 mg/day; trandolapril 2 mg/day; verapamil 240 mg/day or verapamil 180 + trandolapril 2 mg/day combination; forced double-dose titration was carried out at the 4th week. Treatment duration was 6 months. Outcome measures: Changes in BP, 24 h proteinuria, serum albumin and calcium. Results: BP was significantly reduced with the four treatments [SBP/DBP (mmHg]: atenolol 12.2/9.9; trandolapril 12.9/9.3; verapamil 8.2/7.9 and verapamil + trandolapril 13.6/11.3) without differences between them. A significant fall in proteinuria was seen in the trandolapril, 40.2% [95% confidence interval (CI) 24.3-56.2%], and verapamil + trandolapril groups, 48.5% (95% CI, 31.7-64.3%) accompanied with increases in serum albumin (trandolapril: from 3.86 ± 0.64 to 4.03 ± 0.67 g/dl; verapamil + trandolapril: from 4.15 ± 0.58 to 4.40 ± 0.51 g/dl). Conclusions: In patients with proteinuric primary renal disease, adequate dose titration of antihypertensive drugs may provide a substantial BP reduction. Only angiotensin-converting enzyme inhibitor (trandolapril) treatment, alone or better combined with verapamil, reduces proteinuria and increases serum albumin.

Original languageEnglish (US)
Pages (from-to)729-737
Number of pages9
JournalJournal of hypertension
Volume20
Issue number4
DOIs
StatePublished - Apr 2002

Keywords

  • Blood pressure
  • Primary renal disease
  • Proteinuria
  • Trandolapril
  • Verapamil

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology

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