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Renoprotection with and without blood pressure reduction.
Gozewijn Dirk Laverman1, Steen Andersen, Peter Rossing
1Division of Nephrology, Department of Internal Medicine, and Department of Clinical Pharmacology, University of Groningen, Groningen, The Netherlands. gd_laverman@hotmail.com
Kidney International. Supplement
|March 9, 2005
Summary
Losartan effectively reduces albuminuria in patients with type 1 diabetes and non-diabetic kidney disease. Optimal albuminuria reduction may require higher losartan doses than those needed for blood pressure control.
Area of Science:
- Nephrology
- Pharmacology
- Cardiology
Background:
- Angiotensin II receptor (AT1) blockade lowers blood pressure (BP) and albuminuria.
- Both BP and albuminuria reduction are independent renoprotective targets.
- The optimal dosing strategy for achieving both targets is not well-defined.
Purpose of the Study:
- To determine the optimal dose of losartan for reducing albuminuria.
- To investigate if BP response influences albuminuria reduction.
- To assess if higher losartan doses are needed for maximal albuminuria reduction.
Main Methods:
- Two studies were conducted in type 1 diabetic (DM) and non-diabetic (ND) renal patients.
- Patients received escalating doses of losartan (50, 100, 150 mg/day).
- BP and 24-hour albuminuria were measured at each dose; patients were categorized by BP response.
Main Results:
- Losartan reduced albuminuria dose-dependently in both good and poor BP responders.
- Patients with poor BP response still showed significant albuminuria reduction.
- Albuminuria continued to decrease with higher losartan doses, even after BP targets were met.
Conclusions:
- A lack of significant BP response to losartan does not prevent albuminuria reduction.
- Maximal albuminuria reduction may necessitate losartan dosing beyond that required for optimal BP control.
- Individualized dose titration is crucial for achieving renoprotective goals.