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Prabhu D, Rao A, Rajanna A, Kannan S, Kumar S. Urinary Albumin to Creatinine Ratio to Predict Diabetic Retinopathy: The Eyes Have It! Cureus 2022; 14:e22902. [PMID: 35273895 PMCID: PMC8901084 DOI: 10.7759/cureus.22902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 12/21/2022] Open
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Fici F, Ari Bakir E, Ilkay Yüce E, Kanuncu S, Makel W, Tarim BA, Robles NR. PAIT-Survey Follow-Up: Changes in Albuminuria in Hypertensive Diabetic Patients with Mild-Moderate Chronic Kidney Disease. High Blood Press Cardiovasc Prev 2020; 27:43-49. [PMID: 31916208 DOI: 10.1007/s40292-020-00358-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/01/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Albuminuria is an early marker of kidney disease and reduction of albuminuria translates into a decreased occurrence of cardiovascular and renal outcomes. AIMS To evaluate the changes in the prevalence of albuminuria in diabetic hypertensive patients treated with several combinations of renin-angiotensin aldosterone system with calcium channel blockers. METHODS We analysed data from 668 unselected patients from the PAIT survey (mean age 60.4 ± 10.2 years, prevalence of males 38%), with and without albuminuria, maintained for 6 months with the previous treatment with amlodipine-valsartan, amlodipine perindopril, lercanidipine-enalapril, verapamil-trandolapril, nitrendipine-enalapril and felodipine-ramipril Albuminuria was assessed, as urinary albumin-creatinine ratio, using a Multistic-Clinitek device analyzer. Microalbuminuria was defined as a loss of 3.4-33.9 mg albumin/mmol creatinine (30-300 mg/g) and macroalbuminuria as a loss of > 33.9 mg albumin/mmol creatinine (> 300 mg/g). Blood pressure was measured with a validated digital device. RESULTS At baseline, albuminuria was present in 310 subjects (46.4%) (microalbuminuria in 263 (84.8%), macroalbuminuria in 15.2%), and normoalbuminuria in 53.6% 358. After 6 months, the prevalence of subjects with albuminuria was significantly lowered (p < 0.01) by 23.5% (microalbuminuria - 23.9%, p < 0.01 and macroalbuminuria - 21.3%). The prevalence of subjects with microalbuminuria was reduced with all treatments: amlodipine-valsartan - 15.6%, amlodipine-perindopril - 11.8%, lercanidipine-enalapril - 41.3% and verapamil-trandolapril - 19.2%. Data with nitrendipine-enalapril and felodipine-ramipril were not analyzed, due to the low number of patients. The frequency of patients with normoalbuminuria was significantly higher (p < 0.01) with lercanidipine-enalapril compared with any other treatment. Blood pressure was significantly (p < 0.01) reduced, with a similar effect between treatments. CONCLUSIONS The treatments decrease the prevalence of subjects with albuminuria, showing a significant difference among the different drug combinations, favoring the use of new dihydropyridine calcium channel blockers, such as lercanidipine, combined with RAAS inhibitors, to control albuminuria in diabetic hypertensive patients.
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Affiliation(s)
- Francesco Fici
- Catedra de Riesgo Cardiovascular, Universidad de Salamanca, Salamanca, Spain
| | - Elif Ari Bakir
- Department of Nephrology, Bahcesehir University Hospital, Istanbul, Turkey
| | | | | | - Wim Makel
- Clinical Research Facilities International B.V, Schaijk, The Netherlands
| | | | - Nicolás Roberto Robles
- Catedra de Riesgo Cardiovascular, Universidad de Salamanca, Salamanca, Spain. .,Hospital Universitario de Badajoz, Badajoz, Spain. .,Unidad de Hipertensión Arterial, Hospital Infanta Cristina, Carretera de Portugal s/n, 06080, Badajoz, Spain.
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Mancia G, Tsioufis K. Current perspective on the use of calcium channel blockers to treat hypertensive patients: the role of lercanidipine. Future Cardiol 2019; 15:259-266. [PMID: 31180724 DOI: 10.2217/fca-2019-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The symposium 'Current perspective on the use of calcium channel blockers in the treatment of hypertensive patients', held in Stresa (Italy) on 28th and 29th June 2018 with the participation of the main experts in the field of hypertension from all over the world, reviewed the role of calcium channel blockers in the management of hypertension. Considering the new European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines presented at the last European Society of Hypertension meeting in Barcelona in June 2018, a special attention was focused on lercanidipine. In this article, the main highlights of the symposium were summarized.
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Affiliation(s)
- Giuseppe Mancia
- Clinical Medicine Department, University of Milano-Bicocca, Milan, Italy
| | - Kostantinos Tsioufis
- Cardiology Department, First Cardiology Clinic, Medical School, National & Kapodistrian University of Athens, Hippokration Hospital, Greece
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Grassi G, Robles NR, Seravalle G, Fici F. Lercanidipine in the Management of Hypertension: An Update. J Pharmacol Pharmacother 2017; 8:155-165. [PMID: 29472747 PMCID: PMC5820745 DOI: 10.4103/jpp.jpp_34_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 09/14/2017] [Accepted: 12/11/2017] [Indexed: 01/08/2023] Open
Abstract
Calcium channel blockers (CCBs), particularly dihydropyridine-CCBs, (DHP-CCBs), have an established role in antihypertensive therapy, either as monotherapy or in combination with other antihypertensive drugs. Two hundred and fifty-one papers published in PubMed in English between January 1, 1990, and October 31, 2016, were identified using the keyword "lercanidipine." Lercanidipine is a lipophilic third-generation DHP-CCB, characterized by high vascular selectivity and persistence in the smooth muscle cell membranes. Lercanidipine is devoid of sympathetic activation, and unlike the first and second generation of DHP-CCBs, it dilates both the afferent and the efferent glomerular arteries, while preserving the intraglomerular pressure. In addition, lercanidipine prevents renal damage induced by angiotensin II and demonstrates anti-inflammatory, antioxidant, and anti-atherogenic properties through an increasing bioavailability of endothelial nitric oxide. It is associated with a regression of microvascular structural modifications in hypertensive patients. The efficacy of lercanidipine has been demonstrated in patients with different degrees of hypertension, in the young and elderly and in patients with isolated systolic hypertension. In patients with diabetes and renal impairment, lercanidipine displays a renal protection with a significant decrease of microalbuminuria and improvement of creatinine clearance. Lercanidipine is well tolerated and is associated with a very low rate of adverse events, particularly ankle edema, compared with amlodipine and nifedipine. In conclusion, lercanidipine produces a sustained blood pressure-lowering activity with a high rate of responder/normalized patients, associated with a favorable tolerability profile.
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Affiliation(s)
- Guido Grassi
- Clinica Medica of the University of Milano-Bicocca and IRCCS Multimedica, Milan, Italy
| | | | - Gino Seravalle
- San Luca Hospital, Italian Auxological Institute, Milan, Italy
| | - Francesco Fici
- Clinica Medica of the University of Milano-Bicocca and IRCCS Multimedica, Milan, Italy
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Adachi S, Miura SI, Shiga Y, Arimura T, Morii J, Kuwano T, Kitajima K, Iwata A, Morito N, Fujimi K, Yahiro E, Nishikawa H, Saku K. Effects of Tolvaptan With or Without the Pre-Administration of Renin-Angiotensin System Blockers in Hospitalized Patients With Acute Decompensated Heart Failure. Int Heart J 2017; 58:385-392. [DOI: 10.1536/ihj.16-220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Sen Adachi
- Department of Cardiology, Fukuoka University School of Medicine
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University School of Medicine
| | - Joji Morii
- Department of Cardiology, Fukuoka University School of Medicine
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine
| | - Ken Kitajima
- Department of Cardiology, Fukuoka University School of Medicine
| | - Atsushi Iwata
- Department of Cardiology, Fukuoka University School of Medicine
| | - Natsumi Morito
- Department of Cardiology, Fukuoka University School of Medicine
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine
| | - Eiji Yahiro
- Department of Cardiology, Fukuoka University School of Medicine
| | | | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine
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Robles NR, Calvo C, Sobrino J, Espinel E, Esteban R, Mateos L, Macias JF. Lercanidipine valuable effect on urine protein losses: the RED LEVEL study. Curr Med Res Opin 2016; 32:29-34. [PMID: 27779460 DOI: 10.1080/03007995.2016.1218838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The RED LEVEL study (REnal Disease: LErcanidipine Valuable Effect on urine protein Losses) directly compares, in an explorative fashion, the effects of lercanidipine + enalapril and amlodipine + enalapril combinations on renal parameters in hypertensive subjects. RESEARCH DESIGN AND METHODS This was a 1 year, prospective, multi-center, randomized, open-label, blinded-endpoint (PROBE) study in hypertensive patients with albuminuria. MAIN OUTCOME MEASURES Renal function (albuminuria, serum creatinine, creatinine clearance, estimated glomerular filtration rate and proteinuria); blood pressure. RESULTS Albuminuria was significantly reduced, compared with baseline values, with the lercanidipine + enalapril combination over the entire study period; at month 3, month 6 and month 12, changes from baseline were: -162.5 (p-value = 0.0439), -425.8 (p-value = 0.0010), -329.0 (p-value = 0.0011) mg/24 h), respectively. On the other hand, this improvement was not observed with enalapril + amlodipine. Other parameters of renal function such as serum creatinine, creatinine clearance, estimated glomerular filtration rate and proteinuria did not change over the study. Both lercanidipine + enalapril and amlodipine + enalapril significantly reduced systolic and diastolic blood pressure values from baseline all over the study period with no significant differences between groups. Safety outcomes were comparable between the two groups. CONCLUSIONS Overall, the results of this explorative study lend support to the anti-albuminuric effect of the lercanidipine + enalapril combination and to the long term renal-protective effects of this combination in patients with hypertension.
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Affiliation(s)
| | - Carlos Calvo
- b Complejo Hospitalario Universitario de Santiago de Compostela , Santiago de Compostela , Spain
| | - Javier Sobrino
- c Hospital del Esperit Sant, Santa Coloma de Gramanet , Barcelona , Spain
| | | | | | - Lourdes Mateos
- f Juan F Macias. Hospital Clínico Universitario de Salamanca , Salamanca , Spain
| | - Juan F Macias
- f Juan F Macias. Hospital Clínico Universitario de Salamanca , Salamanca , Spain
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Tsioufis K, Tsioufis C, Dimitriadis K, Mantzouranis E, Mani I, Tousoulis D. Differential effects of lercanidipine/enalapril versus amlodipine/enalapril and hydrochlorothiazide/enalapril on target organ damage and sympathetic activation in non-obese essential hypertensive subjects. Curr Med Res Opin 2016; 32:35-41. [PMID: 27779461 DOI: 10.1080/03007995.2016.1218839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The aim of the present study was to compare the effects of the combination of lercanidipine/enalapril versus amlodipine/enalapril and hydrochlorothiazide/enalapril on blood pressure, target organ damage and sympathetic activation in patients with grade 2 essential hypertension. RESEARCH DESIGN AND METHODS This was a 3 month, randomized, blinded-endpoint study in essential hypertensive patients. MAIN OUTCOME MEASURES Office and ambulatory blood pressure, arterial stiffness, urinary albumin to creatinine ratio, renal arterial resistive index, and muscle sympathetic nerve activity were evaluated at baseline, after a 2 week run-in placebo period, at 1 month and at 3 months. RESULTS In total, 56 patients were assigned to lercanidipine/enalapril (n = 19), enalapril/amlodipine (n = 18) and hydrochlorothiazide/enalapril (n = 19). Each pharmacological combination tested was effective in reducing office blood pressure at 1 month and 3 months, and 24 h ambulatory blood pressure at 3 months. Renal arterial resistive index (RI) significantly improved at 1 month and 3 months compared with baseline in all groups. However in the lercanidipine/enalapril and hydrochlorothiazide/enalapril groups, RI was favorably reduced (0.53 ± 0.03 and 0.54 ± 0.04 respectively, p < 0.05) in comparison with the enalapril/amlodipine RI value (0.57 ± 0.03) at 3 months. Moreover, after 3 months of treatment, a significant decrease (by -5.47 bursts/min) (p < 0.05) in muscle sympathetic nerve activity was observed in the lercanidipine/enalapril group (50.79 ± 6.49) compared with baseline (56.26 ± 6.05), while no differences were detected in the amlodipine/enalapril and hydrochlorothiazide/enalapril groups. CONCLUSIONS Our study provides evidence of the efficacy of the lercanidipine/enalapril combination in ameliorating hypertension-related target organ damage and in reducing sympathetic overdrive.
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Affiliation(s)
- K Tsioufis
- a University of Athens, Hippokration Hospital , Athens , Greece
| | - Costas Tsioufis
- a University of Athens, Hippokration Hospital , Athens , Greece
| | | | | | - Ilianna Mani
- a University of Athens, Hippokration Hospital , Athens , Greece
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Robles NR, Fici F, Grassi G. Dihydropyridine calcium channel blockers and renal disease. Hypertens Res 2016; 40:21-28. [DOI: 10.1038/hr.2016.85] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 05/23/2016] [Accepted: 05/27/2016] [Indexed: 01/10/2023]
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Abstract
BACKGROUND Clinical research in the field of hypertension is now increasingly focusing on the potential effects of antihypertensive treatments that may go beyond the reduction of blood pressure (BP). In particular, renal protection appears as a desirable goal, especially considering that hypertension is associated with an increased risk of developing kidney damage, which may eventually lead to end-stage renal disease and a higher mortality. Dihydropyridine calcium channel blockers (CCBs) are widely used in the field of hypertension therapy but the different renal effects of the various CCBs have been poorly explored to date. SCOPE This review will discuss available evidence on the renal effects of two calcium channel blockers: amlodipine and lercanidipine, on the basis of clinical data. METHODS MEDLINE and EMBASE were searched for inclusion of relevant studies. No limitations in time were considered. RESULTS Results from preclinical and clinical studies suggest that amlodipine is overall less effective in terms of renal protection when compared with other antihypertensive tested agents. Its beneficial effect in retarding the progression of renal disease is achievable only when combined with a blocker of the renin-angiotensin system. Conversely lercanidipine seems to provide renal protection in a similar way to ACE inhibitors, probably thanks to its mechanism of action which acts directly on the afferent and efferent renal arterioles. CONCLUSIONS Treatment of hypertension with CCBs should take into consideration the special effects of each single agent at different levels; lercanidipine for example may play a useful role in the management not only of hypertension but also in renal protection of hypertensive patients.
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Affiliation(s)
- Michel Burnier
- University Hospital of Lausanne , Lausanne , Switzerland
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Minushkina LO. COMBINATION THERAPY IN THE MANAGEMENT OF ARTERIAL HYPERTENSION: EFFECTIVENESS OF THE LERCANIDIPINE AND ENALAPRIL COMBINATION. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2013. [DOI: 10.15829/1728-8800-2013-5-75-80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This review presents the evidence on the benefits of fixed-dose combination therapy for arterial hypertension management. The focus is on the combination of a third-generation dihydropyridine calcium antagonist lercanidipine and an ACE inhibitor enalapril. Lercanidipine is characterised by high vascular selectivity and lipophilicity, good antihypertensive effectiveness, and prolonged, gradually developing therapeutic effects. Literature data on the effectiveness of the lercanidipine-enalapril combination are presented. This combination facilitates a marked reduction in blood pressure levels, which is particularly relevant for elderly patients and patients with diabetes mellitus or obesity. The combination of pharmacologic effects of lercanidipine and enalapril provides additional benefits in terms of organ protection and reduction of adverse effects of the antihypertensive treatment.
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Affiliation(s)
- L. O. Minushkina
- Medical Education and Research Centre, RF President Administration, Moscow
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Escobar C, Echarri R, Barrios V. Emerging drug combinations to optimize renovascular protection and blood pressure goals. Int J Nephrol Renovasc Dis 2012; 5:69-80. [PMID: 22536084 PMCID: PMC3333805 DOI: 10.2147/ijnrd.s7048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Hypertension and renal disease are closely related. In fact, there is an inverse linear relationship between renal function and prevalence of hypertension. Hypertensive patients with renal dysfunction exhibit a poor clinical profile, which markedly increases their risk for cardiovascular outcomes. This review considers the available evidence on the best therapeutic approach for optimizing renovascular protection in the hypertensive population. To effectively reduce or at least slow the establishment and progression of renal disease in the hypertensive population it is critical to reach blood pressure targets. Many studies have shown that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prevent or at least delay the development of microalbuminuria in patients with hypertension and type 2 diabetes, reduce the incidence of overt diabetic nephropathy, and are also beneficial in patients with nondiabetic renal disease. Therefore, renin-angiotensin system (RAS) inhibition plays a key role in the prevention of renal outcomes. As the majority of patients with hypertension will need at least two antihypertensive agents to achieve blood pressure goals, the use of RAS inhibitors is a mandatory part of antihypertensive therapy. The question of which antihypertensive agent is the best choice for combining with RAS blockers should be considered. Many studies have shown that diuretics and calcium channel blockers are the best choice. However, more studies are needed to clarify the subgroups of patients who will benefit more from a combination with a diuretic or from a combination with a calcium channel blocker. To date, RAS inhibitors recommended in this context are angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Aliskiren, the first oral direct renin inhibitor available, has shown promising results.
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Affiliation(s)
- Carlos Escobar
- Department of Cardiology, Hospital Infanta Sofía, Madrid, Spain
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Cicero AF, Gerocarni B, Rosticci M, Borgh C. Blood Pressure and Metabolic Effect of a Combination of Lercanidipine with Different Antihypertensive Drugs in Clinical Practice. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2012. [DOI: 10.15829/1728-8800-2012-1-36-40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The aim of this study is to assess the blood pressure (BP) and metabolic effects of lercanidipine when combined with other classes of first-line antihypertensive drugs in day-to-day clinical practice. For this study, we consecutively enrolled 162 patients with uncomplicated primary hypertension, who are partial responders to the treatment with lercanidipine over a period of 24 months. Patients were then allocated to the combination of lercanidipine (10–20 mg/day) with β-blockers, diuretics, angiotensin-converting enzyme inhibitors, and angiotensin-II receptor blockers according to compelling indications (if any) and/or suggestions of European Society of Hypertension–European Society of Cardiology (ESH–ESC) guidelines. All the enrolled patients completed the study and no adverse drug reaction was registered during the research period. The association of a second drug with lercanidipine determined an additional BP decrease of either systolic BP or diastolic BP independently from the type of drug added (P always <0.05). The additional effect of lercanidipine appears widely distributed with no significant differences in the size of BP decrease. From the metabolic point of view, the addition of a second drug did not determine a significant variation in the serum levels of total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol (P always >0.05). Conversely, a significant decrease in fasting plasma glucose and serum levels of triglycerides has been observed in patients where lercanidipine has been combined with an angiotensin-converting enzyme inhibitor or an angiotensin-II receptor blocker. In conclusion, in our study we observed that lercanidipine-based protocols are well tolerated and efficacious in reducing BP. Moreover, the association of lercanidipine with renin–angiotensin system blockers is also associated with significant improvements in triglycerides and fasting plasma glucose.
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Affiliation(s)
- Arrigo F.G. Cicero
- Department of Internal Medicine, Aging and Kidney Diseases, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna
| | - Beatrice Gerocarni
- Department of Internal Medicine, Aging and Kidney Diseases, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna
| | - Martina Rosticci
- Department of Internal Medicine, Aging and Kidney Diseases, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna
| | - Claudio Borgh
- Department of Internal Medicine, Aging and Kidney Diseases, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna
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Cicero AFG, Gerocarni B, Rosticci M, Borghi C. Blood Pressure and Metabolic Effect of a Combination of Lercanidipine with Different Antihypertensive Drugs in Clinical Practice. Clin Exp Hypertens 2011; 34:113-7. [DOI: 10.3109/10641963.2011.601381] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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