Failure of losartan to control blood pressure in scleroderma renal crisis

Caskey, FJ; Thacker, E. A.; Pa, Johnston; Barnes, JN

doi:10.1016/s0140-6736(05)61568-1

Cited by 52 publications

(26 citation statements)

References 3 publications

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“…Enalapril demonstrated the same efficacy in SRC among patients with intolerance to captopril [44]. Angiotensin receptor blockers (ARBs) offer a theoretical benefit, but compared with ACE inhibitors, clinical experience with these agents has been variable [45]. Thus, ARBs are not recommended for SRC [14,45].…”

Section: Curative Treatmentmentioning

confidence: 99%

The Scleroderma Kidney: Progress in Risk Factors, Therapy, and Prevention

Bussone¹,

Bérezné²,

Pestre³

et al. 2010

Curr Rheumatol Rep

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Scleroderma renal crisis (SRC) is characterized by malignant hypertension, oliguric/anuric acute renal failure, and important mortality, with a 5-year survival rate of 65%. SRC occurs in 2% to 5% of patients with systemic sclerosis (SSc), particularly those with diffuse cutaneous SSc in the first years of disease evolution. Several retrospective studies have found high-dose corticosteroid therapy to be associated with increased risk of SRC, and anti-RNA-polymerase III antibodies have been detected in one third of patients with SRC. Treatment relies on the early control of blood pressure with increasing doses of angiotensin-converting enzyme inhibitors, eventually associated with calcium channel blockers together with dialysis if necessary. After 2 years on dialysis, eligible patients should be considered for renal transplantation. The strategy for prevention of SRC lacks consensus. However, corticosteroids and/or nephrotoxic drugs should be avoided in patients with diffuse cutaneous SSc.

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Section: Curative Treatmentmentioning

confidence: 99%

The Scleroderma Kidney: Progress in Risk Factors, Therapy, and Prevention

Bussone¹,

Bérezné²,

Pestre³

et al. 2010

Curr Rheumatol Rep

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“…A small number of patients with primary RP have been treated with low doses of losartan, and a significant improvement in RP episodes was demonstrated in that study (15). The efficacy of losartan in secondary RP has not been studied, although 1 case report did not demonstrate its benefit in the treatment of established scleroderma renal crisis (16).…”

mentioning

confidence: 99%

Losartan therapy for Raynaud's phenomenon and scleroderma: Clinical and biochemical findings in a fifteen-week, randomized, parallel-group, controlled trial

Dziadzio

Denton

Smith

et al. 1999

Arthritis & Rheumatism

277

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Objective. To compare the efficacy and tolerability of losartan, an antagonist of angiotensin II receptor type 1, with nifedipine for the treatment of primary and secondary Raynaud's phenomenon (RP) in a pilot study.Methods. In a randomized, parallel-group, controlled trial, patients with primary RP (n ‫؍‬ 25) or RP secondary to systemic sclerosis (SSc [scleroderma]; n ‫؍‬ 27) were allocated to receive 12 weeks' treatment with either losartan (50 mg/day) or nifedipine (40 mg/day). Primary outcome variables were the severity and frequency of RP episodes and findings on vascular measurements, including thermography and laser Doppler flowmetry. Serum levels of soluble adhesion molecules, endothelin 1, fibrinogen, von Willebrand factor, and procollagen type I N-terminal propeptide (PINP) were also measured.Results. There was a reduction in the severity of RP episodes following treatment with losartan and with nifedipine, but this effect was greater in the losartan arm of the study (P < 0.05): episode frequency was reduced only in the losartan group (P < 0.01 versus baseline). Symptomatic improvement was associated with a significant reduction in soluble vascular cell adhesion molecule 1 and PINP (P < 0.01). Subgroup analysis suggested that although these biochemical changes occurred mainly in SSc patients, the clinical benefit was greater in the primary RP group.Conclusion. This study confirms the tolerability of short-term treatment of RP with losartan, and our data suggest its clinical benefit. Further evaluation of this drug as a long-term treatment for SSc-associated RP should be considered, since it may have additional disease-modifying potential.Episodic digital ischemia provoked by cold and emotion was first described by Maurice Raynaud over 130 years ago (1). When it occurs in isolation, it is designated primary Raynaud's phenomenon (RP) to distinguish it from those cases in which there is an underlying or associated pathology. It affects ϳ10% of the adult population, with a predilection for females, and up to 5% of patients presenting with this condition later develop an autoimmune rheumatic disorder, such as systemic sclerosis (SSc; scleroderma) (2). Successful treatment is often difficult, and although clinical trials suggest that vasodilators can be effective, the responses of individual patients to a particular agent are often idiosyncratic.The pathogenesis of the vascular dysfunction underlying RP is incompletely understood, and relatively few well-controlled clinical trials with vasoactive drugs have been undertaken. Lack of distinction between primary and secondary RP in some of these studies makes their interpretation difficult. Calcium channel antagonists such as nifedipine have been shown to be effective (3-6), although striking differences in individual responses have been described (3,7). Moreover, efficacy is often particularly limited in patients with RP

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“…There are reports suggesting that angiotensin receptor blockers (ARBs) alone are less effective that ACEi in treating SRC [36,37]. There is no evidence regarding the role of direct renin inhibitors.…”

Section: Other Antihypertensivesmentioning

confidence: 99%