Kidney-protective effects of azelnidipine versus a diuretic in combination with
olmesartan in hypertensive patients with diabetes and albuminuria: a randomized
study.
Author(s): Kojima M(1), Okubo S, Mizubayashi R, Isaka N, Machida H, Okamoto S, Hirota H,
Takeuchi M, Kato T, Nakatani K, Mizuno O, Miyagawa K, Makino K, Okura T, Dohi Y,
Ito M, Kimura G.
Affiliation(s): Author information:
(1)Department of Internal Medicine, Komono Kosei Hospital, Komono, Japan.
Publication date & source: 2013, Nephrol Dial Transplant. , 28(7):1802-10
BACKGROUND: A thiazide diuretic used in combination with benazepril is superior
to amlodipine plus benazepril in reducing albuminuria in hypertensive patients
with diabetes. However, calcium channel blockers have diverse characteristics.
Thus, we investigated whether combining an angiotensin receptor blocker with
either azelnidipine or a thiazide diuretic produced similar reductions in
albuminuria in hypertensive diabetic patients for the same levels of blood
pressure achieved.
METHODS: Hypertensive patients with type 2 diabetes and albuminuria (30-600 mg/g
creatinine) under antihypertensive treatment (mean age 67.0±7.6 years) were
instructed to stop all antihypertensive treatment and take a combination of
olmesartan (20 mg/day) and amlodipine (5 mg/day) for 3 months (run-in period).
Then, patients were randomly assigned to receive either olmesartan plus
azelnidipine (16 mg/day; n=71) or olmesartan plus trichlormethiazide (1 mg/day;
n=72) for an additional 6 months. The primary end point was urinary excretion of
albumin at 6 months after randomization.
RESULTS: At the time of randomization, urinary albumin was 116.0 and 107.8 mg/g
creatinine (geometric mean) in the azelnidipine and diuretic arms, respectively,
and was reduced to a similar extent [79.8 (95% confidence interval 66.4-96.0) and
89.7 (74.6-107.7) mg/g creatinine, respectively, after adjustment for baseline
values]. Blood pressure did not differ between the two groups throughout the
study period.
CONCLUSIONS: Azelnidipine is equally effective as a thiazide diuretic in reducing
urinary albumin when used in combination with olmesartan.
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