Vol.14, No 2, 2007 pp. 75 - 81
UC 616.61:615.254
ANTIHYPERTENSIVE DRUG USE AND URINARY
ALBUMIN EXCRETION IN NON-DIABETIC HYPERTENSIVE POPULATION
Zorica Jović1, Vidojko Djordjević2,
Karin Vasić1, Snežana Cekić3,
Irena Janković4
1Department of Pharmacology and Toxicology,
Medical Faculty, University of Niš, Serbia
2Department of Internal Medicine, University
Clinical Center, Niš
3Department of Physiology, Medical
Faculty, University of Niš
4Medical Faculty, University of Niš
E-mail: karin12675@yahoo.com
Summary. Arterial hypertension together with proteinuria is one
of the most important factors associated with the progression of both diabetic
and nondiabetic chronic kidney disease. Reduction of blood pressure is
an efficient way of slowing the progression of this damage whereas antihypertensive
drugs vary in their proteinuria- and microalbuminuria-lowering effects.
The objective of the present study was to determine the influence of different
antihypertensive drug groups on urinary albumin excretion (UAE) as related
to blood pressure in non-diabetic subjects. Subjects (n=39) with chronic
renal disease accompanied by mild-to-moderate hypertension and varying
degrees of proteinuria were included in the study. Patients were divided
into three groups based on UAE values (normoalbuminurics, microalbuminurics
and macroalbminurics) and were placed on usual care including nonpharmacological
and/or treatment with an antihypertensive drug regime (consisting of one
or more out of three different antihypertensive drugs (beta-blocker, ACE
inhibitor or calcium-channel blocker) to achieve target blood pressure
? 130/85 mmHg. Periodic UAE measurements were performed until regression
or significant reduction. A reduction in UAE was observed over time in
most patients. However, it reached statistical significance only in the
microalbuminuric group (p < 0.01). To further analyze the impact of
different antihypertensive drugs on UAE, all patients were stratified into
groups depending on the assigned therapy. They were divided into the following
5 groups: 0 – nonpharmacological treatment; 1 – assigned drug group
1; 12 – assigned drug groups 1 and 2; 13 – assigned drug groups 1 and
3; 123 – assigned all 3 drug groups where '1' stood for ACE inhibitors,
'2' for beta blockers and '3' for calcium channel blockers. A statistically
significant change in mean UAE values at the start and end of the study
period in patients assigned to drug groups 12, 13 and 123 was achieved
(p<0.05). Also, a statistically significant difference existed in the
average reduction of proteinuria under varying antihypertensive drug regimens
(p<0.05, ANOVA). Post hoc analyses revealed also a significant difference
between groups 0 and 13 (p<0.01, Dunnett T3) as well as groups 1 and
13 (p<0.01, Dunnett T3). In patients with hypertension, changes in UAE
depend on the initial UAE values and the type of antihypertensive treatment.
ACE inhibitors combined with calcium channel blockers produced higher UAE
reduction than other drug groups.
Key words: Antihypertensive
drugs, urinary albumin excretion, proteinuria, hypertension, angiotensin-converting
enzyme inhibitors, calcium channel blockers
UTICAJ UPOTREBE ANTIHIPERTENZIVA NA PROTEINURIJU
KOD BOLESNIKA SA HRONIČNOM BUBREŽNOM INSUFICIJENCIJOM I HIPERTENZIJOM
Kratak sadržaj: Arterijska hipertenzija i proteinurija su glavni
faktori koji utiču na progresiju hronične bubrežne insuficijencije (HBI).
Sniženje vrednosti krvnog pritiska je efikasna mera kojom se može usporiti
ova progresija. Antihipertenzivi variraju u svojoj sposobnosti da smanje
vrednosti proteinurije i mikroalbuminurije. Cilj ovog rada je bio da se
odredi uticaj raznih antihipertenziva na vrednosti proteina u urinu (UAE)
kod pacijenata koji nisu dijabetičari, sa blagom do umerenom hipertenzijom
i HBI. Studija je obuhvatila pacijente sa HBI (n=39), blagom-do-umerenom
hipertenzijom i proteinurijom. Pacijenti su podeljeni u 3 grupe na osnovu
vrednosti proteina u mokraći (pacijenti sa normoalbuminurijom, mikroalbuminurijom
i makroalbuminurijom). Započeta je terapija nefarmakološkim merama i
primenom jednog ili više antihipertenziva koji su bili na raspolaganju
(beta-blokatori, ACE inhibitori i kalcijumski blokatori) kako bi se dostigle
ciljne vrednosti tenzije od ?130/85mmHg. Povremena merenja proteinurije
su učinjena dok se nije zapazio pad ili značajno sniženje vrednosti.
Smanjenje vrednosti proteina u mokraći registrovano je kod većine pacijenata,
ali je ovo smanjenje bilo statistički značajno samo u grupi pacijenata
sa mikroalbuminurijom (p<0.01). Kako bi se dalje analizirao uticaj antihipertenziva
na UAE, pacijenti su podeljeni u grupe na osnovu ordinirane terapije. Podeljeni
su u 5 grupa: 0 –nefarmakološke mere; 1 –oprimali lek 1. grupe; 12
– primali lekove iz 1. i 2. grupe; 13 – primali lekove iz 1. i 3. grupe;
123 – primali lekove iz sve 3 grupe, gde su grupu 1 činili ACE inhibitori,
2-beta blokatori i 3-kalcijumski blokatori. Statistički značajna razlika
u prosečnim vrednostima UAE na početku i kraju studije zabeležena je
u grupama 12, 13, i 123 (p<0.05). Postojala je i statistički značajna
razlika u prosečnom smanjenju proteinurije pri upotrebi različitih grupa
lekova (p<0.05, ANOVA). Post hok analizom utvrđeno je da je postojala
razlika izmedju 0 i 13 grupe (p<0.01, Dunnett T3) i 1 i 13 grupe
(p<0.01, Dunnett T3). Kod pacijenata sa hipertenzijom u sklopu HBI,
promene u UAE zavise od početnih vrednosti i vrste propisanog antihipertenziva.
ACE inhibitori u kombinaciji sa kalcijumskim blokatorima doveli su do većeg
pada vrednosti UAE u odnosu na druge kombinacije antihipertenziva.
Ključne reči: Antihipertenzivi,
proteinurija, mikroalbuminurija, ACE inhibitori, kalcijumski blokatori
