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Article Review/Hyperlink
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Guasch A, Parham M, Zayas C, Campbell O, Nzerue C, Macon E
Contrasting effects of calcium channel blockade versus
converting enzyme inhibition on proteinuria in
African Americans with NIDDM nephropathy
J Am Soc Nephrol
(May) 8:793-798 1997

Black patients, particularly older black patients, tend to respond
better to calcium
antagonists than to ACE inhibitors. However, in black patients
with NIDDM and
proteinuria, the renal effects of antihypertensive drugs need to be
considered. In
Caucasian patients, dihydropyridine calcium antagonists (DHP-CAs)
sometimes worsen
proteinuria, whereas non-dihydropyridine calcium antagonists
(NDHP-CAs) may have a
beneficial effect. For example,
Bakris et al showed that the antiproteinuric effects of
verapamil or diltiazem
were similar to those of lisinopril and better than atenolol in
patients with NIDDM. In
blacks specifically with established diabetic renal disease,
Bakris et al showed that verapamil was shown to be
more renoprotective than
atenolol. In contrast to the apparent renoprotective effects of
NDHP-CAs, dihyropyridine
CAs (DHP-CAs) are known to have no effect on proteinuria in
diabetes, e.g., see
Abbott et al. In this paper, Guasch et al simply extend
what is known in
general re DHP-CAs and proteinuria in NIDDM specifically to black
patients with this
disease.
They randomized 31 black patients with NIDDM and proteinuria (about
3g/day) to receive
either isradipine (a DHP-CA) or captopril. 29/31 were
hypertensive, and the washout
period before baseline assessment was quite short (2 weeks), during
which time BP was
controlled with clonidine plus a diuretic. The drugs doses were
isradipine 2.5 BID or
captopril 25 mg TID. After a 6 month follow up period, despite
similar final levels of BP
control, proteinuria had increased by 50% in the isradipine group
whereas it had decreased
by about 30% in the ACE inhibitor group. Because initial systolic
BP was slightly higher
in the isradipine group, the change in BP actually tended to be
greater in the isradipine
group.
Comment: Although the results confirm that DHP-CAs are not
the drug of choice for
patients with NIDDM and proteinuria, use of NDHP-CAs in African
American patients with
NIDDM and proteinuria may have a beneficial effect, and in
particular, combination therapy
with ACE inhibitors and NDHP-CAs may be of benefit.
(John T. Daugirdas, M.D., University of Illinois at
Chicago)
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