Reduction in microalbuminuria by calcium channel blockers in patients with type 2 diabetes mellitus and hypertension-A randomized, open-label, active-controlled, superiority, parallel-group clinical trial

Abstract

SummaryBackgroundIt has been suggested that renoprotection with calcium channel blockers (CCBs) may differ. This study aimed to compare the anti‐proteinuric effect of different CCBs in patients with type 2 diabetes (T2D).MethodsA multicentre, randomized, open‐label, active‐controlled study was performed in seven centres in Korea. A total of 74 patients with T2D and microalbuminuria treated with renin‐angiotensin system (RAS) blockers were randomized to a cilnidipine 10 mg treatment (n=38) or amlodipine 5 mg treatment (n=36).ResultsUrine albumin to creatinine ratio (ACR) reduction was similar between the two groups at 12 weeks (−53.0±123.2 mg/g in cilnidipine group and −35.7±83.6 mg/g in amlodipine group, P=.29) or 24 weeks (−57.3±106.9 mg/g in cilnidipine group and −20.0±110.4 mg/g in amlodipine group, P=.24). In a subgroup analysis, cilnidipine treatment showed a larger ACR reduction than amlodipine treatment at 12 weeks (−84.7±106.8 mg/g in cilnidipine group and −9.5±79.2 mg/g in amlodipine group, P=.01) and 24 weeks (−84.0±111.7 mg/g in cilnidipine group and 14.6±119.4 mg/g in amlodipine group, P=.008), particularly in patients with a longer duration of diabetes more than 10 years.ConclusionsCilnidipine did not show any additional anti‐albuminuric effect compared with amlodipine in patients with T2D and microalbuminuria treated with an RAS blocker. However, the anti‐albuminuric effect of cilnidipine might differ according to the duration of diabetes.

Evaluating the antiproteinuric efficacy of cilnidipine in diabetic kidney disease

“…This increase can be attributed to a decrease in the serum creatinine levels. 5 There was also a reduction in the mean UPCR after 12 weeks of treatment with cilnidipine this was in accordance to a number of studies one such study done by Fujita et al demonstrated a similar reduction in the UPCR levels. 12 Another study by Kojima et al also demonstrated a decline in the UPCR levels of nearly 10% after cilnidipine treatment for a period of 6 months.…”

“…The mean age of the study population was 61.64±10.74 years similar to the mean age observed in another study by Hwang et al which included patients with a mean age of 61±8.5 years. 5 This might be because most of the patients enrolled in the study were diagnosed as having diabetic nephropathy developing mostly 10-15 years following the onset of diabetes, also a number of epidemiological studies conducted in India have shown an association between increasing age and incidence of nephropathy. 6 But in comparison to these studies there are a number of other studies that have a mean age which is much lesser to our current study one such study conducted in Vatsalya hospital, Karnataka by Malleshappa had a mean age of only 44.9±13.4 years, but this can be attributed to the small sample size of the study.…”

Efficacy of Cilnidipine (L/N-type Calcium Channel Blocker) in Treatment of Hypertension: A Meta-Analysis of Randomized and Non-randomized Controlled Trials

“… Minami et al [ 17 ]; Sakata et al [ 18 ]; Takeda et al [ 19 ]; Rose et al [ 20 ]; Kojima et al [ 21 ]; Tsuchihashi et al [ 22 ]; Morimoto et al [ 23 ]; Fujita et al [ 24 ]; Hong et al [ 25 ]; Konoshita et al [ 26 ]; Abe et al [ 27 ]; Miwa et al [ 28 ]; Abe et al [ 29 ]; Kanoaka et al [ 30 ]; Adake et al [ 11 ]; Singh et al [ 31 ]; Pathapati et al [ 32 ]; Masaki et al [ 33 ]; Das et al [ 34 ]; Singal et al [ 35 ]; Hwang et al [ 36 ]; Oh et al [ 37 ]; Kawabata et al [ 38 ]; Fujiwara et al [ 39 ] …”

“…FIGURE 2: Forest plot for change in SBP (K=24) SBP: systolic blood pressure; REML: random-effects model; SD: standard deviation; CI: confidence intervals Minami et al [17]; Sakata et al [18]; Takeda et al [19]; Rose et al [20]; Kojima et al [21]; Tsuchihashi et al [22]; Morimoto et al [23]; Fujita et al [24]; Hong et al [25]; Konoshita et al [26]; Abe et al [27]; Miwa et al [28]; Abe et al[29]; Kanoaka et al[30]; Adake et al[11]; Singh et al[31]; Pathapati et al[32]; Masaki et al[33]; Das et al[34]; Singal et al[35]; Hwang et al[36]; Oh et al[37]; Kawabata et al[38]; Fujiwara et al[39] …”

“…FIGURE 8: Forest plot for change in PR (K=12) PR: pulse rate; REML: random-effects model; SD: standard deviation: CI: confidence intervals Sakata et al [18]; Takeda et al [19]; Kojima et al [21]; Hong et al [25]; Miwa et al [28]; Abe et al [29]; Kanoaka et al [30]; Adake et al [11]; Singh et al [31]; Masaki et al [33]; Das et al [34]; Hwang et al[36]; Kawabata et al[38] …”