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KMID : 0648320030090020117
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Journal of The Korean Society of Hypertension
2003 Volume.9 No. 2 p.117 ~ p.124
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Short-Term Effect of ACE inhibitor and ATⅡ Receptor Blocker on Non-diabetic Renal Disease Patients
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Song Joon-Ho
Lim Hee-Jung
Lee Sun-Young
Park Geun-Ho
Lee Chung-Won
Kim Eun-A
Lim Joo-Hwan
Lee Seoung-Woo
Kim Moon-Jae
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Abstract
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Background: The combination therapy of ACE inhibitors and angiotensin Ⅱ receptor blockers might be additive in renal protection since they block the action of angiotensin Ⅱ at the different level of renin-angiotensin system. The result has been inconsistent in the previous studies on the effect of combination therapy according to underlying renal diseases. To examine the benefit of the combination therapy of ACE inhibitor and angiotensin Ⅱ receptor blocker, we underwent a crossover therapeutic trial of the combination therapy in patients with non-diabetic renal diseases.
Methods: Nineteen patients with biopsy-proven IgA nephropathy, as an example of non-diabetic renal diseases, were selected as study subjects, who met criteria of creatinine clearance between 25-90 ml/min/1.73m2, 24-hr urinary protein excretion rate over than 1.0 g/day, and blood pressure maintained less than 130/80 mmHg with more than six-month therapy of ramipril. After a 12-week stabilization period (control period), 4 mg once daily dose of candesartan (combination period) followed by placebo (placebo period), or vice versa, were added on ramipril each for 12 weeks.
Results: The combination of candesartan did not changed Ccr, BP, and serum and urinary electrolytes and urea. Twenty-four hour urinary protein excretion rate was significantly reduced by the combination therapy (3.1±0.3 g/day in combination, 4.2±0.3 in control, and 4.3±0.2 in placebo; P<0.05). The change in proteinuria showed no relationship with the change of BP.
Conclusions: In conclusions, the combination therapy of ACE inhibitors and angiotensin Ⅱ receptor blockers showed additive antiproteinuric effect that was independent of blood pressure change. The results implicate the importance of pathophysiological role of the renin-angiotensin system in non-diabetic renal diseases.
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KEYWORD
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ACE inhibitors, Angiotensin Ⅱ receptor blockade, Non-diabetic renal diseases
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