Hemmelder MH, de Zeeuw D, de Jong PE
Verapamil is not as effective as ACE inhibition in the
reduction of non-diabetic proteinuria
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1334 1996
Different calcium channel blockers have different effects on
proteinuria. In diabetic patients, verapamil but not nifedipine
has antiproteinuric effects similar to those of ACE inhibitors. In
a randomized double-blind cross-over trial, the efficacy of
verapamil SR (360 mg), the ACE inhibitor trandolapril (4 mg) and a
fixed combination of these drugs (180/2 mg) on proteinuria was
studied in 11 non-diabetic patients with proteinuria > 3.0 g/d and
creatinine clearance > 40 ml/min. Proteinuria was significantly
reduced by all 3 treatments, but the reduction was significantly
less with verapamil alone (-12%) vs. -51% and -41% with ACE
inhibitor and combination therapy. However, verapamil also did not
reduce diastolic BP. The authors conclude that verapamil is not as
effective as ACE inhibitors in the reduction of proteinuria in non-diabetic
patients.
Comment: The strong point of this study is its rigorous design.
However, the low number of patients studied and the lack of
comparable antihypertensive efficacy make interpretation of
clinical significance difficult.
(David J. Leehey, M.D., Loyola University at Chicago)
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Am Soc Nephrol
H: Pathophysiology :
Kidney in hypertension
H: Drug therapy :
Calcium channel blockers