A Comparative Effectiveness Study of Renal Parameters Between Imidapril and Amlodipine in Patients with Hypertension: A Retrospective Cohort Study

Abstract

IntroductionImidapril is an angiotensin converting enzyme inhibitor (ACEI) that is frequently used as an antihypertensive drug in Japan. Although ACEIs are known to have adverse effects of decreasing glomerular filtration rate (GFR) and causing hyperkalemia, there are very few clinical data on the long-term effect of imidapril on glomerular function. We conducted a retrospective cohort study using a clinical database to evaluate and compare the long-term effects of imidapril and amlodipine on renal parameters in Japanese hypertensive patients in routine clinical practice.MethodsWe identified cohorts of new users of imidapril (n = 57) and a propensity score-matched group with an equal number of new users of amlodipine (n = 57). We used a multivariable regression model to evaluate and compare the effects of the drugs on laboratory parameters including serum levels of creatinine, potassium, sodium, blood urea nitrogen, and estimated GFR (eGFR) between imidapril users and amlodipine users up to 12 months after the initiation of study drug administration. The mean exposure of imidapril and amlodipine was 226.2 and 235.2 days, respectively.ResultsWe found a significant increase of serum creatinine and potassium levels and a decrease of eGFR in imidapril users from the baseline period to the exposure period. The reduction of eGFR and the increase of serum creatinine and potassium levels in imidapril users were significantly greater than those in amlodipine users.ConclusionsOur study showed that imidapril decreased eGFR and increases the serum levels of creatinine and potassium compared with amlodipine, at least during 1 year of administration.

Identifying Antidepressants Less Likely to Cause Hyponatremia: Triangulation of Retrospective Cohort, Disproportionality, and Pharmacodynamic Studies

“…Prescriptions are coded using the Japanese drug coding system, which is mapped to the Anatomical Therapeutic Chemical (ATC) classification. Several epidemiological studies have been previously published evaluating the effects of various drugs on laboratory parameters using NUSM’s CDW 17–20 . The experimental protocol was approved by the Ethical Committee of NUSM (approval number: P21‐01‐0), and the study was conducted in compliance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects of the Ministry of Education, Culture, Sports, Science, and Technology and the Ministry of Health, Labour, and Welfare, Japan.…”

Gambaran Penggunaan Obat Antihipertensi Terhadap Kadar Kreatinin Pada Pasien Stroke Di Instaalsi Rawat Jalan Rsud Dungus Madiun

“…Berdasarkan penelitian sebelumnya melaporkan adanya efek jangka panjang penggunaan Angiotensin Converting Enzyme Inhibitor (ACEI) pada parameter fungsi ginjal pasien hipertensi. Sedangkan golongan Calcium Chanel Blocker (CCB) yaitu amplodipin memiliki efek penurunan fungsi ginjal lebih rendah bahkan tidak mempengaruhi parameter fungsi ginjal (Nishida et al, 2017) Mengingat kurangnya perhatian atas efek samping jangka panjang dari penggunaan obat antihipertensi dan ke tidakefektifan obat antihipertensi sehingga, banyak kasus pasien yang mengalami gagal ginjal dan baru diketahui saat pasien sudah memasuki stadium akhir (Irawan, 2014). Hal ini selayaknya menjadi perhatian dan evaluasi apabila efek samping ini diketahui lebih awal maka penurunan fungsi ginjal dan kerusakan fungsi ginjal pada pasien stroke dapat dicegah lebih awal.…”

“…Pada pasien yang menggunkaan antihipertensi golongan CCB kadar kreatinin relatif menurun, dengan rata rata penurunan 0,03 mg/ dL, namun masih dalam batas normal (0,6-1,2 mg/dL). Hal ini selaras dengan penelitian (Nishida et al, 2017) yang menyatakan bahwa golongan CCB tidak mempengaruhi parameter fungsi ginjal karena efek amplodipin terhadap kadar kreatinin serum pada pasien hipertensi tidak berbeda dengan efek plasebo, artinya golongan ini aman karena kurang memiliki kemampuan meningkatkan kadar kreatinin secara signifikan yang akan mempengaruhi aktifitas fungsi ginjal sehingga memperburuk kondisi pasien stroke.…”

Evidence of Drug–Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update

“…In both cases it should be noted patients were also taking a beta blocker. Conversely, two retrospective cohort studies in hypertensive patients who were taking either a CCB or an alternative anti-hypertensive medication found no association between CCB use and increased serum potassium [ 102 , 103 ].…”