Angiotensin converting enzyme inhibition reduces proteinuria in Nigerians with chronic renal disease

Ajayi, A. A.; Ajayi, A T

doi:10.1007/bf00315425

Cited by 3 publications

(2 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This combination is also the preferred treatment in (HT-DM) Nigerians, because it has been shown to lower blood pressure, significantly decrease 24 h proteinuria and raise plasma albumin concentrations in Nigerian patients, with the comorbidity. 29,30 The improvement in the overall care and control of hypertension in our centre is probably the culmination of several factors. These include a separate hypertension clinic and management by a team guided by an agreed treatment protocol, through the development of a hospital drug formulary, drug compliance reinforcement by family intervention, as well as continuous education of the prescribers in the clinical pharmacology of antihypertensive drugs.…”

Section: Discussionmentioning

confidence: 99%

“…Although ACEI monotherapy of essential hypertension in Nigerians 13 and other blacks patients is of poor antihypertensive efficacy, ACEI+D has been shown to control BP and reverse proteinuria in hypertensive-diabetics 29 as well as in patients with chronic renal disease. 30 ACEIs have also reduced hospital mortality in Nigerians with hypertensive heart failure. 31 In the present study, concurrent hypertension with diabetes (HT-DM) was present in 22% of all the patients, a value higher than the earlier study result of 12%.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Shifting trends in the pharmacologic treatment of hypertension in a Nigerian tertiary hospital: a real-world evaluation of the efficacy, safety, rationality and pharmaco-economics of old and newer antihypertensive drugs

et al. 2003

View full text Add to dashboard Cite

The current prescription patterns for essential hypertension and the efficacy, safety, tolerability and costeffectiveness of the newer antihypertensive drugs were evaluated in Nigerian patients. The findings were compared with that of a previous study conducted in the same tertiary hospital 10 years earlier. A crosssectional evaluation of blood pressure (BP) control in a hypertension clinic was undertaken among 150 Nigerian patients aged 61712 years (55% females), with a duration of treatment on a particular drug class or combination of 973 months. The initial blood pressure was 176720/108711 mmHg and 22% of the patient had concurrent diabetes mellitus. Thiazide diuretics (D) alone or in combination remained the most commonly prescribed drugs in 56% of all patients. There were significant increases in the prescriptions of calcium channel blockers (CCBs) (51%), Po0.0001, and ACEinhibitors (ACEIs) (24%), Po0.0001, but a slight reduction in the use of methyldopa, and fixed drug combinations (Po0.01) compared to the previous study. The fall in systolic blood pressure on D (r ¼ 0.65, Po0.001) or CCB (r ¼ 0.48, Po0.02) was significantly correlated with the initial systolic blood pressure, but not age. More patients achieved normotension BPo140/90 mmHg on CCB monotherapy (71%), than D monotherapy (56%). Combination therapy with ACEIs+D or methyldopa+thia-zides normalized BP in 63 and 68%, respectively. Pulse pressure, a surrogate marker for cardiovascular complications and mortality in essential hypertension, was significantly reduced (Po0.01) equally by all treatments, with 95% confidence intervals ranging from À28 to À1 mmHg. However, hypertensive-diabetic (HT-DM) patients (n ¼ 33) exhibited no significant change in pulse pressure in response to treatment. Adverse drug reactions that occurred in 11% were impotence or postural dizziness with D, headache and pitting oedema with CCB, and dry cough with ACEI. Pharmaco-economic comparison of the drug classes revealed that for every US dollar ($) spent per month, the percentage of treated patients attaining normotension was 18.6 for D, 4.73 for CCB, 3.5 for ACEI+D and 13.6 for methyldopa+thiazides. A combination of ACEI+CCB or D was the preferred treatment for hypertensive-diabetic Nigerians, but only 24% attained a BPo130/85 mmHg. These results demonstrate a shift in trend to a more rational and efficacious treatment of hypertension over a 10 year period. This may be associated, at least in part, with the intensive and continuous education of the prescribers in rational drug use and the introduction of a hospital formulary. Methyldopa is still a highly efficacious and costeffective drug in this population. Black HT-DM Africans still constitute a subgroup who not only require more and costlier antihypertensive drugs, but whose BP control is suboptimal, and exhibit a poor therapeutic response to other risk factors (pulse pressure) that constitute a continuing risk for cardiovascular mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Shifting trends in the pharmacologic treatment of hypertension in a Nigerian tertiary hospital: a real-world evaluation of the efficacy, safety, rationality and pharmaco-economics of old and newer antihypertensive drugs

et al. 2003

View full text Add to dashboard Cite

show abstract

Angiotensin-converting enzyme inhibitors and progression of nondiabetic chronic renal disease

Wee¹

1993

Archives of Internal Medicine

View full text Add to dashboard Cite

Hypertension in Africa and Effectiveness of Its Management with Various Classes of Antihypertensive Drugs and in Different Socio-Economic and Cultural Environments

Salako

1993

Clinical and Experimental Hypertension

View full text Add to dashboard Cite

Hypertension is the commonest cardiovascular disease in Africans occurring in more than 15% of the adult population in some studies. It occurs in the lower as much as in the higher socio-economic groups. Recent studies have confirmed earlier findings that essential hypertension in Africans is characterised by volume loading, low plasma renin activity, high salt taste threshold, high urinary sodium and low potassium excretion and high plasma aldosterone. The commonest complication of hypertension in Africans is congestive cardiac failure followed by cerebrovascular accidents. Coronary heart disease is rare. Even in the absence of overt heart failure and compounding factors like obesity, alcoholism, cigarette smoking, diabetes mellitus and myocarditis, evidence of abnormal left ventricular morphology and function is often present in newly diagnosed patients with moderate or severe hypertension. Response to monotherapy with beta-blockers or ACE inhibitors is usually poor but is good with thiazide diuretics or calcium channel blockers. The diuretics are an essential component of a two or three drug regime containing other classes of antihypertensive drugs. Cost of drugs is the most important determinant of compliance with drug treatment and consequently the likelihood of progression of the diseases to more severe forms in long term follow-up.

show abstract

Angiotensin converting enzyme inhibition reduces proteinuria in Nigerians with chronic renal disease

Cited by 3 publications

References 7 publications

Shifting trends in the pharmacologic treatment of hypertension in a Nigerian tertiary hospital: a real-world evaluation of the efficacy, safety, rationality and pharmaco-economics of old and newer antihypertensive drugs

Shifting trends in the pharmacologic treatment of hypertension in a Nigerian tertiary hospital: a real-world evaluation of the efficacy, safety, rationality and pharmaco-economics of old and newer antihypertensive drugs

Angiotensin-converting enzyme inhibitors and progression of nondiabetic chronic renal disease

Hypertension in Africa and Effectiveness of Its Management with Various Classes of Antihypertensive Drugs and in Different Socio-Economic and Cultural Environments

Contact Info

Product

Resources

About