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Nephroprotective effects of nitrendipine in hypertensive type I and type II diabetic patients
R G Bretzel1, C C Bollen, E Maeser
1Third Department of Medicine and Policlinic, University of Giessen, Germany.
Abstract:
Hypertension is significantly involved in the progression of diabetic nephropathy and in the development of end stage renal disease in both type I and type II diabetes mellitus. We have investigated whether long-term monotherapy with a calcium antagonist, nitrendipine, prevents the development of overt diabetic nephropathy in type I and type II diabetic patients with mild to moderate hypertension and persistent microalbuminuria (ie, incipient nephropathy). After a 4-week run-in and washout period, respectively, 25 patients met the inclusion criteria. Twenty-two patients (six with type I and 16 with type II diabetes) completed the 12-month study. Twelve months of treatment with nitrendipine resulted in a significant reduction in systolic blood pressure in patients with type I (157.5 +/- 8.1 mm Hg v 135.8 +/- 4.2 mm Hg, P < 0.05) and type II (163.1 +/- 4.3 mm Hg v 135.9 +/- 3.6 mm Hg, P < 0.001) diabetes. A significant reduction also was seen in diastolic blood pressure (91.7 +/- 1.7 mm Hg v 79.2 +/- 3.5 mm Hg in type I diabetic patients, P < 0.01; 94.7 +/- 1.4 mm Hg v 78.1 +/- 1.5 mm Hg in type II diabetic patients, P < 0.001). A significant reduction in albuminuria was associated with the blood pressure reduction in both type I (57.8 +/- 11.9 mg/24 hr v 24.9 +/- 5.9 mg/24 hr, -57%) and type II (134.6 +/- 20.7 mg/24 hr v 70.3 +/- 16.8 mg/24 hr, -48%) diabetic patients. The mean glomerular filtration rate increased by 21% (112 +/- 12 mL/min v 135 +/- 14 mL/min) and by 23% (106 +/- 12 mL/min v 130 +/- 14 mL/min) in type I and type II diabetic patients, respectively. No significant changes were found in renal plasma flow rates or in serum concentrations of beta 2-microglobulin. With the exception of a significant (P < 0.05) reduction in hemoglobin A1 concentration in type II diabetic patients after 3 months of treatment with nitrendipine, fasting blood glucose, hemoglobin A1, residual beta-cell function (C-peptide levels), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and body mass index remained essentially unchanged during follow-up. These findings suggest that 12 months of monotherapy with the dihydropyridine-type calcium antagonist nitrendipine reduced albuminuria and increased the lowered glomerular filtration rate without adverse effects on glucose and lipid control.(ABSTRACT TRUNCATED AT 400 WORDS)
Insights
Long-term monotherapy with nitrendipine significantly reduced blood pressure and albuminuria in diabetic patients with incipient nephropathy. This treatment also improved glomerular filtration rate without negatively impacting glucose or lipid control.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Hypertension accelerates diabetic nephropathy progression and end-stage renal disease in both type I and type II diabetes.
- Microalbuminuria indicates incipient nephropathy, a critical stage for intervention.
Purpose of the Study:
- To investigate if long-term monotherapy with nitrendipine prevents overt diabetic nephropathy in hypertensive patients with incipient nephropathy.
- To assess the effects of nitrendipine on blood pressure, albuminuria, and renal function in type I and type II diabetes.
Main Methods:
- A 12-month study involving 22 patients (6 type I, 16 type II diabetes) with mild to moderate hypertension and persistent microalbuminuria.
- Patients received monotherapy with nitrendipine after a run-in and washout period.
- Evaluated changes in systolic and diastolic blood pressure, albuminuria, glomerular filtration rate (GFR), and other metabolic parameters.
Main Results:
- Nitrendipine significantly reduced systolic and diastolic blood pressure in both type I and type II diabetic patients.
- A significant reduction in albuminuria was observed, with a -57% decrease in type I and -48% in type II diabetes.
- Mean GFR increased by 21% in type I and 23% in type II diabetes, with no adverse effects on glucose or lipid control.
Conclusions:
- Twelve months of nitrendipine monotherapy effectively reduces albuminuria and improves GFR in diabetic patients with incipient nephropathy.
- Nitrendipine is a safe therapeutic option for managing hypertension and incipient nephropathy in diabetic patients, without compromising glycemic or lipid profiles.