Effects of Monotherapy of Temocapril or Candesartan with Dose Increments or Combination Therapy with Both Drugs on the Suppression of Diabetic Nephropathy

• Published in: Hypertension research Vol. 30; no. 4; pp. 325 - 334
• Main Authors: Ogawa, Susumu, Takeuchi, Kazuhisa, Mori, Takefumi, Nako, Kazuhiro, Tsubono, Yoshitaka, Ito, Sadayoshi
• Format: Journal Article
• Language: English
• Published: England 01.04.2007
• Subjects: Aged; Albuminuria - drug therapy; Albuminuria - etiology; Albuminuria - physiopathology; Angiotensin II Type 1 Receptor Blockers - economics; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - economics; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Benzimidazoles - economics; Benzimidazoles - therapeutic use; Blood Pressure - drug effects; Blood Pressure - physiology; Cost-Benefit Analysis; Creatinine - urine; Diabetes Mellitus, Type 2 - complications; Diabetic Nephropathies - drug therapy; Diabetic Nephropathies - etiology; Diabetic Nephropathies - physiopathology; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Hypertension - complications; Hypertension - drug therapy; Hypertension - physiopathology; Male; Middle Aged; Tetrazoles - economics; Tetrazoles - therapeutic use; Thiazepines - economics; Thiazepines - therapeutic use
• ISSN: 0916-9636; 1348-4214
• DOI: 10.1291/hypres.30.325

We examined the effects of increasing the recommended initial doses of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), or of switching to combination therapy with both drugs, on diabetic nephropathy. Hypertensive type 2 diabetic patients with urinary albumin excretion (ACR) between 100 and 300 mg/g creatinine (Cre) were assigned to the following five groups in which an antihypertensive drug was administered at a recommended initial dose for 48 weeks, and then either the dose was doubled or an additional drugs was added to regimen for the following 48 weeks: N, nifedipine-CR (N) 20 mg/day (initial dose); T, ACEI temocapril (T) 2 mg/day; C, ARB candesartan (C) 4 mg/day; T+C, T first and then addition of C; C+T, C first and then addition of C. ACR decreased in the T (n=34), C (n=40), T+C (n=37) and C+T (n=35) groups, but not in the N group (n=18). However, the anti-proteinuric effect was less in the T than in the C, T+C or C+T groups, while no differences existed among the latter three. In each group, there were significant linear relationships between attained BP and ACR; however, the regression lines were shifted toward lower ACR level in the renin-angiotensin system-inhibition groups compared with the N group. These results indicate that an ACEI and/or ARB is superior to a CCB in retarding diabetic nephropathy, while the combination of low doses of ACEI and ARB has effects similar to those of high-dose ARB. Even among patients treated with an ACEI and/or ARB, lowering BP is important.