Nephrology Dialysis Transplantation, Vol 14, Issue 1 98-104, Copyright © 1999 by Oxford University Press
M Hemmelder, D de Zeeuw and P de Jong
Background: Non-dihydropyridine calcium antagonists
such as verapamil are equally effective in reducing proteinuria as ACE
inhibitors in hypertensive patients with diabetic nephropathy. To date it
is unknown whether verapamil elucidates such an antiproteinuric capacity in
non-diabetic renal disease. Methods: We performed a
double-blind, placebo controlled, random cross-over study which compared
the antiproteinuric effect of 6 weeks treatment with verapamil SR (360 mg)
to that of the ACE inhibitor trandolapril (4 mg), and their fixed
combination vera/tran (180 mg verapamil SR and 2 mg trandolapril) in 11
non-diabetic patients with proteinuria of 6.6 (5.1-8.8) g/day, a creatinine
clearance of 87 &74-106) ml/min, and a 24-h blood pressure of 136/85
(126/76-157/96) mmHg at baseline. Results:
Twenty-four-hour mean arterial pressure did not change during verapamil,
whereas both trandolapril and vera/tran induced a significant reduction in
MAP. Verapamil showed no significant effects on renal haemodynamics.
Trandolapril and vera/tran did not significantly change GFR, but ERPF
increased and FF decreased during both treatments (P<0.05). The
antiproteinuric response of verapamil was significantly less compared to
that of trandolapril and vera/tran (-12% (-17/-1) vs
-51% (-56/-25) and -41% )-50/-19) respectively). The blood pressure and
antiproteinuric response during verapamil tended to be greater in
hypertensive patients than in normotensive patients, although this
difference was not significant. Baseline blood pressure was related to the
change in blood pressure during verapamil (r=-0.70; P<0.02).
Conclusions: The antiproteinuric and antihypertensive
response of verapamil is less than that of the ACE inhibitor trandolapril
in patients with non-diabetic renal disease. In contrast to the
antiproteinuric response of trandolapril, the antiproteinuric response of
verapamil seems to be completely dependent from effective blood pressure
reduction. The fixed combination of verapamil and ACE inhibition at half
doses has similar effects as ACE inhibition as full dose. Key
words: ACE inhibition, non-diabetic renal disease; proteinuria;
verapamil
ORIGINAL ARTICLES
Antiproteinuric efficacy of verapamil in comparison to trandolapril in non-diabetic renal disease
Groningen Institute for Drug Studies (GIDS), Department of Medicine, Division of Nephrology, and Department of Clinical Pharmacology, University Hospital Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
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