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Valsartan and the kidney: present and future.
1Schwabing Hospital, University of Munich, Germany.
Journal of Cardiovascular Pharmacology
|February 24, 1999
Summary
Angiotensin (Ang) II type 1 (AT1) receptor antagonists and angiotensin-converting enzyme (ACE) inhibitors show similar long-term renoprotective effects. Valsartan effectively lowers blood pressure in renal failure patients without altering renal excretory function.
Area of Science:
- Nephrology
- Pharmacology
- Cardiovascular Medicine
Background:
- Angiotensin (Ang) II type 1 (AT1) receptor antagonists and angiotensin-converting enzyme (ACE) inhibitors are key treatments for cardiovascular and renal diseases.
- ACE inhibitors block Ang II incompletely and have bradykinin-potentiating effects, while AT1 receptor antagonists specifically block the AT1 receptor.
- Both drug classes impact glomerular filtration rate (GFR) and proteinuria, with differing acute and long-term effects observed in experimental models.
Purpose of the Study:
- To compare the effects of AT1 receptor antagonists and ACE inhibitors on renal function and proteinuria in various models of renal damage.
- To evaluate the efficacy and renal effects of valsartan, an AT1 receptor antagonist, in patients with moderate to severe renal failure.
Main Methods:
- Review of experimental animal data comparing AT1 receptor antagonists and ACE inhibitors in models of renal damage and proteinuria.
- Analysis of a double-blind trial investigating valsartan in patients with moderate to severe renal failure, assessing blood pressure, GFR, and urine protein changes.
Main Results:
- AT1 receptor antagonists decrease GFR to a lesser degree than ACE inhibitors, and their effect on glomerular pressure is less pronounced.
- While ACE inhibitors show acute proteinuria reduction, both agents provide similar long-term proteinuria reduction and renoprotection in animal models.
- In renal failure patients, valsartan significantly reduced blood pressure without altering GFR, and decreased urine protein compared to placebo.
Conclusions:
- AT1 receptor antagonists and ACE inhibitors are equally renoprotective in the long term, with differing acute effects on GFR and proteinuria.
- Valsartan is effective in lowering blood pressure in renal failure patients, maintaining renal excretory function.
- Long-term renoprotective effects of valsartan require further investigation in ongoing clinical trials.