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Pereira PG, Rabelo K, da Silva JFR, Ciambarella BT, Argento JGC, Nascimento ALR, Vieira AB, de Carvalho JJ. Aliskiren improves renal morphophysiology and inflammation in Wistar rats with 2K1C renovascular hypertension. Histol Histopathol 2019; 35:609-621. [PMID: 31625581 DOI: 10.14670/hh-18-173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hypertension is characterized by persistent elevated blood pressure levels, one of the leading causes of death in the world. Renovascular hypertension represents the most common cause of secondary hypertension, and its progress is associated with overactivation of the renin angiotensin aldosterone system (RAAS), causing systemic and local changes. Aliskiren is a renin-inhibiting drug that optimizes RAAS suppression. In this sense, the objective of the present study was to analyze the morphophysiology of the left kidney in Wistar rats with renovascular hypertension after treatment with Aliskiren. Parameters such as systolic blood pressure, urinary creatinine and protein excretion, renal cortex structure and ultrastructure, fibrosis and tissue inflammation were analyzed. Our results showed that the hypertensive animals treated with Aliskiren presented a reestablishment of blood pressure, expression of renin, and renal function, as well as a remodeling of morphological alterations through the reduction of fibrosis. The treatment regulated the laminin expression and decreased pro-inflammatory cytokines, restoring the integrity of the glomerular filtration barrier. Therefore, our findings suggest that Aliskiren has a renoprotective effect acting on the improvement of the morphology, physiology and pathology of the renal cortex of animals with renovascular hypertension.
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Affiliation(s)
- Priscila G Pereira
- Laboratory of Ultrastructure and Tecidual Biology, Institute of Biology, State University of Rio de Janeiro, RJ, Brazil
| | - Kíssila Rabelo
- Laboratory of Ultrastructure and Tecidual Biology, Institute of Biology, State University of Rio de Janeiro, RJ, Brazil
| | - Jemima F R da Silva
- Laboratory of Ultrastructure and Tecidual Biology, Institute of Biology, State University of Rio de Janeiro, RJ, Brazil
| | - Bianca T Ciambarella
- Laboratory of Ultrastructure and Tecidual Biology, Institute of Biology, State University of Rio de Janeiro, RJ, Brazil
| | - Juliana G C Argento
- Laboratory of Ultrastructure and Tecidual Biology, Institute of Biology, State University of Rio de Janeiro, RJ, Brazil
| | - Ana L R Nascimento
- Laboratory of Ultrastructure and Tecidual Biology, Institute of Biology, State University of Rio de Janeiro, RJ, Brazil
| | - Aline B Vieira
- Ross University School of Veterinary Medicine, Biomedical Department, Basseterre, Saint Kitts
| | - Jorge J de Carvalho
- Laboratory of Ultrastructure and Tecidual Biology, Institute of Biology, State University of Rio de Janeiro, RJ, Brazil.
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Panahpour H, Terpolilli NA, Schaffert D, Culmsee C, Plesnila N. Central Application of Aliskiren, a Renin Inhibitor, Improves Outcome After Experimental Stroke Independent of Its Blood Pressure Lowering Effect. Front Neurol 2019; 10:942. [PMID: 31551909 PMCID: PMC6737892 DOI: 10.3389/fneur.2019.00942] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 08/14/2019] [Indexed: 12/13/2022] Open
Abstract
Epidemiological studies suggest that pharmacological reduction of systemic hypertension lowers incidence and severity of stroke. However, whether the reduction of blood pressure per se or the compounds used to reduce hypertension are responsible for this effect received little attention. In the current study we therefore aimed to investigate whether Aliskiren, a renin-inhibitor used to treat arterial hypertension, may improve outcome in a mouse model of ischemic stroke when applied centrally and in a dose not affecting blood pressure. Male C57BL/6 mice received 0.6, 2.0, or 6.0 μg Aliskiren or vehicle by intracerebroventricular injection as a pre-treatment and were then subjected to 60 min of middle cerebral artery occlusion (MCAo). Infarct volume, brain edema formation, mortality, antioxidant effects, and functional outcome were assessed up to seven days after MCAo. Central administration of Aliskiren (0.6 or 2.0 μg) had no effect on systemic blood pressure but significantly reduced infarct volume and brain edema formation, blunted mortality, and improved neurological outcome up to 1 week after MCAo. Due to the central and prophylactic administration of the compound, we cannot make any conclusions about the potency of Aliskiren for acute stroke treatment, however, our study clearly demonstrates, that in addition to lowering blood pressure Aliskiren seems to have a direct neuroprotective effect. Hence, renin-inhibitors may be an effective addition to prophylactic treatment regimens in stroke patients.
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Affiliation(s)
- Hamdollah Panahpour
- Laboratory of Experimental Stroke Research, Institute for Stroke and Dementia Research (ISD), Munich University Hospital, Munich, Germany.,Department of Physiology, Medical School, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Nicole A Terpolilli
- Laboratory of Experimental Stroke Research, Institute for Stroke and Dementia Research (ISD), Munich University Hospital, Munich, Germany.,Department of Neurosurgery, Munich University Hospital, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - David Schaffert
- Pharmaceutical Biotechnology, Department of Pharmacy, Ludwig-Maximilians University, Munich, Germany
| | - Carsten Culmsee
- Institute for Pharmacology and Clinical Pharmacy, University of Marburg, Marburg, Germany
| | - Nikolaus Plesnila
- Laboratory of Experimental Stroke Research, Institute for Stroke and Dementia Research (ISD), Munich University Hospital, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Simeoni M, Nicotera R, Pelagi E, Libri E, Comi N, Fuiano G. Successful Use of Aliskiren in a Case of IgA- Mesangial Glomerulonephritis Unresponsive to Conventional Therapies. Rev Recent Clin Trials 2019; 14:72-76. [PMID: 30047335 DOI: 10.2174/1574887113666180726103648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 06/16/2018] [Accepted: 06/20/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The early suspension of Altitude trial in recent years has induced most nephrologists and cardiologists to abandon Aliskiren use. Consequently, the potential usefulness of the direct renin inhibition in IgA glomerulonephritis remained an under-investigated therapeutic option. CASE REPORT We report the case of a 53 years old IgA GMN patient unresponsive to all conventional anti-angiotensin-2 agents, steroids and immunosuppressants, in which the administration of Aliskiren permitted to achieve and maintain a complete proteinuria remission in the absence of any adverse event. CONCLUSION Aliskiren might represent a valid and safe therapeutic option in IgA GMN, although further investigations would be needed to confirm this conclusion.
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Affiliation(s)
- Mariadelina Simeoni
- Nephrology Unit, University Hospital 'Magna Graecia', Department of Medical and Surgical Sciences, Catanzaro, Italy
| | - Ramona Nicotera
- Nephrology Unit, University Hospital 'Magna Graecia', Department of Medical and Surgical Sciences, Catanzaro, Italy
| | - Elena Pelagi
- Nephrology Unit, University Hospital 'Magna Graecia', Department of Medical and Surgical Sciences, Catanzaro, Italy
| | - Emanuela Libri
- Nephrology Unit, University Hospital 'Magna Graecia', Department of Medical and Surgical Sciences, Catanzaro, Italy
| | - Nicolino Comi
- Nephrology Unit, University Hospital 'Magna Graecia', Department of Medical and Surgical Sciences, Catanzaro, Italy
| | - Giorgio Fuiano
- Nephrology Unit, University Hospital 'Magna Graecia', Department of Medical and Surgical Sciences, Catanzaro, Italy
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4
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Optimizing inhibition of the renin-angiotensin system in hypertension. J Hypertens 2016; 34:838-41. [PMID: 27027379 DOI: 10.1097/hjh.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Simeoni M, Nicotera R, Colao M, Citraro ML, Pelagi E, Cerantonio A, Comi N, Coppolino G, Fuiano G. Direct inhibition of plasmatic renin activity with aliskiren: a promising but under-investigated therapeutic option for non-diabetic glomerulonephritis. Int Urol Nephrol 2015; 48:229-37. [PMID: 26438325 DOI: 10.1007/s11255-015-1128-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/25/2015] [Indexed: 11/29/2022]
Abstract
Non-diabetic glomerulonephritis is a frequent cause of end-stage renal disease. The use of renin-angiotensin-aldosterone system blockers is a fundamental therapeutic approach. However, converting enzyme inhibitors (ACE-is) and angiotensin receptor blockers do not always achieve the desired target of proteinuria. The induction of the prorenin and renin up-regulation is a possible explanation. Aliskiren is the first drug acting as direct inhibitor of plasmatic renin activity, also able to interfere with the prorenin and renin profibrotic escape. We aimed at reviewing the literature for the assessment of potential efficacy and safety of aliskiren in the treatment of non-diabetic glomerulonephritis. The data on this topic are limited; however, we concluded for a possible usefulness of aliskiren. The renal safety profile appears potentially acceptable in non-diabetic patients although extreme carefulness, particularly with respect to long-term renal and cardiovascular tolerability, is recommended.
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Affiliation(s)
- Mariadelina Simeoni
- Nephrology and Dialysis Unit, University-Hospital "Magna Graecia" of Catanzaro, Viale Europa, 88100, Catanzaro, Italy.
| | - Ramona Nicotera
- Nephrology and Dialysis Unit, University-Hospital "Magna Graecia" of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Maria Colao
- Nephrology and Dialysis Unit, University-Hospital "Magna Graecia" of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Maria Lucia Citraro
- Nephrology and Dialysis Unit, University-Hospital "Magna Graecia" of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Elena Pelagi
- Nephrology and Dialysis Unit, University-Hospital "Magna Graecia" of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Annamaria Cerantonio
- Nephrology and Dialysis Unit, University-Hospital "Magna Graecia" of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Nicola Comi
- Nephrology and Dialysis Unit, University-Hospital "Magna Graecia" of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Giuseppe Coppolino
- Nephrology and Dialysis Unit, University-Hospital "Magna Graecia" of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Giorgio Fuiano
- Nephrology and Dialysis Unit, University-Hospital "Magna Graecia" of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
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Eren Z, Günal MY, Bakir EA, Coban J, Çağlayan B, Ekimci N, Ethemoglu S, Albayrak O, Akdeniz T, Demirel GY, Kiliç E, Kantarci G. Effects of paricalcitol and aliskiren combination therapy on experimental diabetic nephropathy model in rats. Kidney Blood Press Res 2014; 39:581-90. [PMID: 25532067 DOI: 10.1159/000368471] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS The aim of the present study was to investigate the effect of combination of aliskiren with paricalcitol on experimental diabetic nephropathy (DN) model in rats. METHODS Forty male Sprague Dawley rats were divided into 5 groups of 8 rats each, namely the control (Group C), diabetes (Group D), aliskiren (Group A), paricalcitol (Group P), and aliskiren plus paricalcitol (Group A+P) groups. Aliskiren was given by oral-gavage at a dose of 50 mg/kg/day once daily for 12 weeks. Paricalcitol was given by intraperitoneally at a dose of 0,4 µg/kg/three day of week for 12 weeks. Renal function parameters, oxidative stress biomarkers, mRNA expression of renin-angiotensin system parameters and kidney histology were determined. RESULTS Group A+P had lower mean albümin-to-creatinine ratio (ACR) (p=0.004) as well as higher creatinine clearance (CCr) (p<0.005) than the diabetic rats (Group D). Combination therapy significantly increased CCr (Group A+P vs. Group A, p<0.005; Group A+P vs. Group P, p=0.022) and reduced ACR (Group A+P vs. Group A, p=0.018; Group A+P vs. Group P, p<0.005) when compared to monotherapy. Serum malondialdehyde levels were significantly lower (p=0.004); glutathion levels (p=0.003), glutathion peroxidase (p=0.004) and superoxide dismutase (p<0.005) activities were significantly higher in group A+P than in group D. The mean scores of mRNA expression of renin (p<0.005), angiotensin II (p=0.012) and angiotensin type 1 receptor (p=0.018) in group A+P were significantly lower. Although combination therapy showed no additional effect on oxidative system, renin-angiotensin system and renal histology, aliskiren plus paricalcitol significantly decreased interstitial fibrosis volume when compared to monotherapy (Group A+P vs. Group A, p<0.005; Group A+P vs. Group P, p=0.002). CONCLUSION Our data seem to suggest a potential role of aliskiren plus paricalcitol acting synergystically for reducing the progression of diabetic nephropathy in an experimental rat model.
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Affiliation(s)
- Zehra Eren
- Department of Nephrology, Yeditepe University, Istanbul, Turkey
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Riccioni G. The role of direct renin inhibitors in the treatment of the hypertensive diabetic patient. Ther Adv Endocrinol Metab 2013; 4:139-45. [PMID: 24143271 PMCID: PMC3799297 DOI: 10.1177/2042018813490779] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Hypertensive patients with diabetes exhibit an increased risk for cardiovascular complications, such as acute coronary syndrome, stroke, heart failure and chronic kidney disease (CKD). These two chronic diseases are linked to a high rate of morbidity and mortality and for this reason it is important for the clinician to recognize the need for effective treatment of hypertension, which can require combination therapy to achieve blood pressure (BP) goals. Direct renin inhibitors (DRIs) may be useful in combination with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) as they provide a more complete blockade of the renin-angiotensin-aldosterone system (RAAS), effectively suppressing residual angiotensin II production and the counter-regulatory increase in plasma renin activity observed in patients receiving monotherapy with ACEIs or ARBs. Some questions regarding the action of aliskiren in cardiovascular and renal disorders are open. In particular, the combination therapy of aliskiren and a RAAS blocker in diabetic hypertensive patients with CKD is controversial. Several published studies demonstrated that aliskiren is suitable for once-daily administration and its antihypertensive effect is comparable or superior to that of other antihypertensive agents at recommended doses, with a good tolerability profile. At the moment the association with ACEIs and ARBs is not recommended in patients with type 2 diabetes mellitus (T2DM) and renal impairment even if a recent published open-label study of low-dose aliskiren (150 mg/daily) in association with ACEIs or ARBs has demonstrated a good tolerability profile without the adverse events found in other studies. This review provides a brief overview of RAAS blocking, in particular the rationale and clinical evidence supporting the use of the DRI aliskiren, in high-risk patients with T2DM.
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Affiliation(s)
- Graziano Riccioni
- Intensive Cardiology Care Unit, San Camillo de Lellis Hospital, Via G. De Rogatis, 12, 71016 San Severo (FG), Italy
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8
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Lizakowski S, Tylicki L, Rutkowski B. Direct renin inhibition--a promising strategy for renal protection? Med Sci Monit 2013; 19:451-7. [PMID: 23756824 PMCID: PMC3684114 DOI: 10.12659/msm.883949] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Activation of the renin–angiotensin–aldosterone system (RAAS) plays a key role in the progression of chronic kidney disease (CKD). RAAS inhibitors, such as angiotensin converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs), decrease the rate of progression of diabetic and non-diabetic nephropathies and are first-line therapies for CKD. Although these agents are highly effective, current therapeutic strategies are unable to sufficiently suppress the RAAS and stop CKD progression. Aliskiren, the first in a new class of RAAS-inhibiting agents (direct renin inhibitors) has been approved to treat hypertension. Aliskiren exerts renoprotective, cardioprotective, and anti-atherosclerotic effects in animal models that appear to be independent of its blood pressure lowering activity. Early clinical studies using urinary protein excretion as a marker of renal involvement suggest a possibly novel role for aliskiren in treating CKD. This review discusses the antiproteinuric efficacy and safety of aliskiren and considers the evidence for its potential renoprotection.
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Affiliation(s)
- Sławomir Lizakowski
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
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Fogari R, Mugellini A, Zoppi A, Preti P, Maffioli P, Perrone T, Derosa G. Time course of antiproteinuric effect of aliskiren in arterial hypertension associated with type 2 diabetes and microalbuminuria. Expert Opin Pharmacother 2013; 14:371-84. [DOI: 10.1517/14656566.2013.772981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Roberto Fogari
- University of Pavia, Clinica Medica II, Centro Ipertensione e Fisiopatologia Cardiovascolare, Department of Internal Medicine and Therapeutics,
Piazzale Golgi 19, 27100 Pavia, Italy ;
| | - Amedeo Mugellini
- University of Pavia, Clinica Medica II, Centro Ipertensione e Fisiopatologia Cardiovascolare, Department of Internal Medicine and Therapeutics,
Piazzale Golgi 19, 27100 Pavia, Italy ;
| | - Annalisa Zoppi
- University of Pavia, Clinica Medica II, Centro Ipertensione e Fisiopatologia Cardiovascolare, Department of Internal Medicine and Therapeutics,
Piazzale Golgi 19, 27100 Pavia, Italy ;
| | - Paola Preti
- University of Pavia, Clinica Medica II, Centro Ipertensione e Fisiopatologia Cardiovascolare, Department of Internal Medicine and Therapeutics,
Piazzale Golgi 19, 27100 Pavia, Italy ;
| | - Pamela Maffioli
- University of Pavia, Clinica Medica II, Centro Ipertensione e Fisiopatologia Cardiovascolare, Department of Internal Medicine and Therapeutics,
Piazzale Golgi 19, 27100 Pavia, Italy ;
| | - Tiziano Perrone
- University of Pavia, Clinica Medica II, Centro Ipertensione e Fisiopatologia Cardiovascolare, Department of Internal Medicine and Therapeutics,
Piazzale Golgi 19, 27100 Pavia, Italy ;
| | - Giuseppe Derosa
- University of Pavia, Clinica Medica II, Centro Ipertensione e Fisiopatologia Cardiovascolare, Department of Internal Medicine and Therapeutics,
Piazzale Golgi 19, 27100 Pavia, Italy ;
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Gandhi S, Srinivasan B, Akarte AS. Aliskiren improves insulin resistance and ameliorates diabetic renal vascular complications in STZ-induced diabetic rats. J Renin Angiotensin Aldosterone Syst 2012; 14:3-13. [PMID: 22791702 DOI: 10.1177/1470320312452766] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aliskiren, a direct renin inhibitor (DRI), has therapeutic effects in patients with hypertension and associated complications, but its potential mechanism in diabetic nephropathy is lacking. The effects of aliskiren in Streptozotocin (STZ)-induced renal complication in diabetic rats were investigated. Aliskiren treatment for eight weeks at the dose of 10 mg/kg/day, via osmotic mini-pump, induced improvement in blood glucose levels, systolic blood pressure (BP) and serum creatinine. Improvement of insulin resistance by aliskiren was confirmed by increased glucose translocation in liver and muscle and hence insulin levels. The treated group also showed improvement in glomerulosclerosis and tubulointerstitial injury. Aliskiren treatment also improved albumin levels in plasma, suppressed profibrotic and proinflammatory cytokine synthesis viz TNF-α and TGF-β and angiogenesis by a decrease in VEGF. In addition, the level of total proteins and GFR via cystatin c and beta-2microglobulin along with adiponectin and erythropoietin were also improved. These results suggest that the beneficial organ protective effect of aliskiren is mediated by improvement in insulin resistance as well as a direct anti-fibrotic effect in the target organ in STZ-induced diabetic rats with a slight effect on blood pressure. Aliskiren may be a useful therapeutic agent in the treatment of type 2 diabetes and diabetic nephropathy.
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Affiliation(s)
- Sonia Gandhi
- Delhi Institute of Pharmaceutical Sciences and Research, India.
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Abe M, Maruyama N, Suzuki H, Fujii Y, Ito M, Yoshida Y, Okada K, Soma M. Additive renoprotective effects of aliskiren on angiotensin receptor blocker and calcium channel blocker treatments for type 2 diabetic patients with albuminuria. Hypertens Res 2012; 35:874-81. [PMID: 22592665 DOI: 10.1038/hr.2012.45] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This open-label, randomized, parallel-controlled study investigated the effects of the direct renin inhibitor aliskiren on 64 hypertensive type 2 diabetic patients with chronic kidney disease (CKD) and stable glycemic control who were already being treated with fixed doses of antihypertensive agents over a 24-week period. These agents were 80 mg of the angiotensin II receptor blocker (ARB) telmisartan and 5 mg of the calcium channel blocker (CCB) amlodipine. Patients were randomly assigned to two groups: the aliskiren group, receiving 150 mg per day aliskiren, which was increased to 300 mg per day (n=32), and the CCB group, which received an increased dose (7.5 mg per day) of amlodipine that was increased to 10 mg per day (n=32). Urinary albumin excretion and urinary levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG) and liver-type fatty acid-binding protein (L-FABP) were investigated in each group. Mean systolic and diastolic blood pressure decreased significantly in both groups, but there was no significant difference between the two groups at the end of the study. Serum creatinine levels and estimated glomerular filtration rate did not differ significantly between the two groups, but percent changes of urinary albumin/creatinine ratios, 8-OHdG and L-FABP levels decreased significantly in the aliskiren group compared with the CCB group. Plasma aldosterone levels were significantly decreased in the aliskiren group, which correlated significantly with those of urinary 8-OHdG and L-FABP. Our results suggest that the addition of aliskiren to the maximal recommended dose of ARB and usual dose of amlodipine is more effective in reducing albuminuria and oxidant stress in hypertensive diabetic patients with CKD than increasing the dose of amlodipine.
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Affiliation(s)
- Masanori Abe
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan.
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Nakamura T, Sato E, Amaha M, Kawagoe Y, Maeda S, Yamagishi SI. Addition of aliskiren to angiotensin II receptor blockers ameliorates renal tubular injury and reduces intima media thickness of carotid artery in patients with diabetic nephropathy. Int J Cardiol 2011; 155:294-6. [PMID: 22177589 DOI: 10.1016/j.ijcard.2011.11.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 10/21/2011] [Accepted: 11/27/2011] [Indexed: 10/14/2022]
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Nakamura T, Sato E, Amaha M, Kawagoe Y, Maeda S, Yamagishi SI. Addition of aliskiren to olmesartan ameliorates tubular injury in chronic kidney disease patients partly by reducing proteinuria. J Renin Angiotensin Aldosterone Syst 2011; 13:122-7. [DOI: 10.1177/1470320311422580] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Tubular injury is more important than glomerulopathy for renal prognosis in chronic kidney disease (CKD) patients. Numerous studies have demonstrated the active participation of the renin–angiotensin system (RAS) in CKD. However, whether addition of aliskiren, a direct renin inhibitor, to olmesartan improves renal tubular injury in CKD patients is unknown. Methods: This study compared the effects of aliskiren (300 mg daily), olmesartan (40 mg daily), and its combination therapy on urinary L-fatty acid binding protein (L-FABP), a marker of tubular injury in stage I or II CKD patients. It also examined which clinical variables were independently correlated with tubular damage. Results: Olmesartan or aliskiren monotherapy for 6 months comparably decreased blood pressure (BP) and proteinuria. BP and proteinuria levels were reduced more by combination therapy than by either monotherapy. Olmesartan or aliskiren decreased urinary L-FABP level, and combination therapy produced more incremental reduction in L-FABP level relative to each monotherapy. Multiple stepwise regression analysis revealed that BMI, low-density lipoprotein (LDL)-cholesterol and proteinuria were independently related to urinary L-FABP level. Conclusions: The present study demonstrated that addition of aliskiren to olmesartan decreased urinary L-FABP level partly via reduction of proteinuria in stage I or II CKD patients.
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Affiliation(s)
- Tsukasa Nakamura
- Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Chiba, Japan
| | - Eiichi Sato
- Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Chiba, Japan
| | - Mayuko Amaha
- Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Chiba, Japan
| | - Yasuhiro Kawagoe
- Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Chiba, Japan
| | - Sayaka Maeda
- Department of Pathophysiology and Therapeutics of Diabetic Vascular Complications, Kurume University School of Medicine, Fukuoka, Japan
| | - Sho-ichi Yamagishi
- Department of Pathophysiology and Therapeutics of Diabetic Vascular Complications, Kurume University School of Medicine, Fukuoka, Japan
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Atkinson J. Stroke, high blood pressure and the Renin-Angiotensin-aldosterone system - new developments. Front Pharmacol 2011; 2:22. [PMID: 21687514 PMCID: PMC3108479 DOI: 10.3389/fphar.2011.00022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 04/06/2011] [Indexed: 01/13/2023] Open
Abstract
This review considers whether a case can be made for a protective effect of inhibitors and blockers of the renin-angiotensin-aldosterone system (RAAS) on the cerebral circulation. It first looks at whether there exists a preferential effect on the cerebral circulation during a drug-induced lowering of high arterial blood pressure and cardiovascular morbi-mortality. It then goes on to consider background studies on the relationship between inhibition of the RAAS and stroke. This is followed by exploration of possible new directions in the inhibition of the RAAS and its effect on stroke.
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Affiliation(s)
- Jeffrey Atkinson
- Pharmacology Laboratory, Pharmacy Faculty, Nancy UniversityVillers, France
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