A crossover comparison of urinary albumin excretion as a new surrogate marker for cardiovascular disease among 4 types of calcium channel blockers

Konoshita, Tadashi; Makino, Yasukazu; Kimura, Tomoko; Fujii, Miki; Morikawa, Norihiro; Wakahara, Shigeyuki; Arakawa, Kazuhisa; Inoki, Isao; Nakamura, Hiroyuki; Miyamori, Isamu

doi:10.1016/j.ijcard.2011.10.133

Cited by 6 publications

(11 citation statements)

References 46 publications

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“…A total of 1494 studies were identified. Among these studies, twenty-four studies [12] – [35] with a total of 1,696 participants (including 809 studies assessing T-type CCBs versus L-type CCBs and 887 studies assessing T-type CCBs versus RAS antagonists) met the inclusion criteria and were selected for the statistical test (see Table 1 ). Six articles [13] , [16] , [18] , [20] , [21] , [22] lacked data regarding renal function or plasma aldosterone.…”

Section: Resultsmentioning

confidence: 99%

“…However, for DBP and SCr in the T-type CCB vs. RAS groups, the I 2 value was greater than 50%; hence, the random effects model was used. The results of quality assessment for each included study indicated that eighteen reports [13] – [21] , [24] – [27] , [29] – [33] were high quality and that the remaining six studies [12] , [22] – [23] , [28] , [34] – [35] were moderate quality (see Table 1 and Table S1 ). The overall quality of the evidence was high in our statistical tests.…”

Section: Resultsmentioning

confidence: 99%

“…The overall quality of the evidence was high in our statistical tests. The results from the overall risk of bias assessment for each included study indicated that six reports [17] – [19] , [25] – [27] exhibited a low risk of bias, thirteen reports [12] – [14] , [16] , [22] , [24] , [28] – [32] , [34] – [35] exhibited an unclear risk of bias, and the remaining five studies [15] , [20] – [21] , [23] , [33] exhibited a high risk of bias (see Table 1 , Figure S2 and Table S2 ).…”

Section: Resultsmentioning

confidence: 99%

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Effects of T-Type Calcium Channel Blockers on Renal Function and Aldosterone in Patients with Hypertension: A Systematic Review and Meta-Analysis

Xue

Yang

2014

PLoS ONE

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BackgroundHigh blood pressure can cause kidney damage, which can increase blood pressure, leading to a vicious cycle. It is not clear whether the protective effects of T-type calcium channel blockers (T-type CCBs) on renal function are better than those of L-type CCBs or renin-angiotensin system (RAS) antagonists in patients with hypertension.Methods and FindingsPUBMED, MEDLINE, EMBASE, OVID, Web of Science, Cochrane, CNKI, MEDCH, VIP, and WANFANG databases were searched for clinical trials published in English or Chinese from January 1, 1990, to December 31, 2013. The weighted mean difference (WMD) and 95% confidence interval (CI) were calculated and reported. A total of 1494 reports were collected, of which 24 studies with 1,696 participants (including 809 reports comparing T-type CCBs versus L-type CCBs and 887 reports comparing T-type CCB versus RAS antagonists) met the inclusion criteria. Compared with L-type CCBs, T-type CCBs resulted in a significant decline in aldosterone (mean difference = −15.19, 95% CI −19.65–−10.72, p<1×10−5), proteinuria (mean difference = −0.73, 95% CI −0.88–−0.57, p<1×10−5), protein to creatinine ratio (mean difference = −0.22, 95% CI −0.41–−0.03, p = 0.02), and urinary albumin to creatinine ratio (mean difference = −55.38, 95% CI −86.67–−24.09, p = 0.0005); no significant difference was noted for systolic blood pressure (SBP) (p = 0.76) and diastolic blood pressure (DBP) (p = 0.16). The effects of T-type CCBs did not significantly differ from those of RAS antagonists for SBP (p = 0.98), DBP (p = 0.86), glomerular filtration rate (p = 0.93), albuminuria (p = 0.97), creatinine clearance rate (p = 0.24), and serum creatinine (p = 0.27) in patients with hypertension.ConclusionIn a pooled analysis of data from 24 studies measuring the effects of T-type CCBs on renal function and aldosterone, the protective effects of T-type CCBs on renal function were enhanced compared with L-type CCBs but did not differ from RAS antagonists. Their protective effects on renal function were independent of blood pressure.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Effects of T-Type Calcium Channel Blockers on Renal Function and Aldosterone in Patients with Hypertension: A Systematic Review and Meta-Analysis

Xue

Yang

2014

PLoS ONE

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“…When nifedipine CR was administered at night, nocturnal BP was significantly decreased [17], and U-Alb excretion may also be decreased. Second, different kinds of CCBs prevent albuminuria to different degrees [11, 12]. In fact, some reports have indicated that nifedipine CR decreased albuminuria.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, some reports have indicated that nifedipine CR decreased albuminuria. Nifedipine CR and cilnidipine, but not efonidipine and amlodipine, significantly reduced albuminuria [11]. Combination therapy with standard-dose candesartan and nifedipine CR is more effective than up-titrated candesartan monotherapy for reducing BP and improving U-Alb while maintaining eGFR [12].…”

Section: Discussionmentioning

confidence: 99%

Efficacies of Controlling Morning Blood Pressure and Protecting the Kidneys by Treatment With Valsartan and Nifedipine CR or Valsartan and Amlodipine (MONICA Study)

et al. 2013

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BackgroundIt is controversial whether a single-pill fixed-dose combination of angiotensin II type 1 receptor blocker and calcium channel blocker (CCB) is effective for all types of hypertension.MethodsThirty-five patients with uncontrolled blood pressure (BP) under treatment with valsartan 80 mg/day or amlodipine 5 mg/day were enrolled. They were randomly divided into two treatment groups: a single-pill fixed-dose combination of valsartan 80 mg/day and amlodipine 5 mg/day in the morning (VA group), or valsartan 80 mg/day in the morning and nifedipine CR 20 mg/day at night (VN group), and treated for 16 weeks. If the patient did not reach the target office BP at 8 weeks, they received double doses of CCBs.ResultsIn the VN group, morning diastolic BP was significantly lower than the respective values in the VA group at 8 weeks. The percentage of patients who required a double dose of CCB in the VN group was significantly lower than that in the VA group. At 16 weeks, the BP levels in both groups were significantly reduced. Urinary albumin/creatinine at 16 weeks was significantly less than that at 0 weeks in the VN group.ConclusionCombination therapy with valsartan and nifedipine CR may help to control morning BP and protect the kidneys.

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On the top of ARB N/L type Ca channel blocker leads to less elevation of aldosterone

et al. 2016

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The activation of the renin–angiotensin system (RAS) is one of the unfavourable characteristics of calcium channel blocker (CCB). N type calcium channel is thought to be involved in renin gene transcription and adrenal aldosterone release. Accordingly, N/L type CCB has a possibility of less elevation of plasma aldosterone concentrations (PAC) among CCBs. In a monotherapy study, we had already demonstrated that N/L type CCB leads to less activation of the RAS compared with L type CCB. The objective of this study is to substantiate the hypothesis that at the condition of additive administration on the top of an angiotensin receptor blocker (ARB), still N/L type CCB leads to less elevation of PAC compared with L type one. Subjects were 60 hypertensives administered with valsartan. As an open label study, amlodipine (L type) or cilnidipine (N/L type) were administered on the top of valsartan (ARB) in a cross-over manner. Results were as follows (valsartan+amlodipine compared with valsartan+cilnidipine): systolic blood pressure (SBP)/diastolic blood pressure (DBP) (mmHg): 132±10/76±10 compared with 131±10/77±9, P=0.95/0.48, plasma renin activity (PRA) (ng/ml·h): 2.41±2.67 compared with 2.00±1.50 P=0.20, PAC (pg/ml): 77.3±31.0 compared with 67.4±24.8, P<0.05, urinary albumin excretion (UAE) (mg/gCr): 105.9±216.1 compared with 73.9±122.2, P<0.05. Thus, PAC at cilnidipine was significantly lower than those at amlodipine in spite of the comparable BP reductions. Besides, UAE was significantly lower at cilnidipine. In conclusion, on the top of the ARB, it is suggested that cilnidipine administration might lead to less elevation of PAC and reduction in UAE compared with amlodipine.

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A crossover comparison of urinary albumin excretion as a new surrogate marker for cardiovascular disease among 4 types of calcium channel blockers

Cited by 6 publications

References 46 publications

Effects of T-Type Calcium Channel Blockers on Renal Function and Aldosterone in Patients with Hypertension: A Systematic Review and Meta-Analysis

Effects of T-Type Calcium Channel Blockers on Renal Function and Aldosterone in Patients with Hypertension: A Systematic Review and Meta-Analysis

Efficacies of Controlling Morning Blood Pressure and Protecting the Kidneys by Treatment With Valsartan and Nifedipine CR or Valsartan and Amlodipine (MONICA Study)

On the top of ARB N/L type Ca channel blocker leads to less elevation of aldosterone

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