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Title: Dissociation between blood pressure reduction and fall in proteinuria in primary renal disease: A randomized double-blind trial
Authors: Ruilope, Luis M.
Fernández, R.
Rodríguez-Pérez, J. C. 
García de Vinuesa, S.
Garrido, J.
Romero, R.
Jarillo, D.
Raij, L.
Alvarez-Cantalapiedra, I.
Lázaro de Mercado, Ma R.
Gómez Campderá, F.
Jarillo Ibáñez, D.
García Martín, F.
Mora-Maciá, J.
Nieto, J.
Vozmediano, C.
Hortal, L.
Plaza, C.
Aljama, P.
Gómez-Carrasco, J. M.
Soriano, S.
Pérez-García, A.
Garcés, L.
Segura, J.
Bonet, J.
Vigil-Medina, A.
Gallar, P.
Oliet, A.
Bernis, C.
Sánz-Guajardo, D.
UNESCO Clasification: 32 Ciencias médicas
3205 Medicina interna
Keywords: Blood pressure
Primary renal disease
Issue Date: 2002
Journal: Journal of Hypertension 
Abstract: Objective: Guidelines recommend lower threshold and goal blood pressure (BP) for patients with proteinuria. BP reduction could be accompanied by a different fall in proteinuria depending of the antihypertensive drug. The objective was to compare proteinuria reduction when BP is lowered to the same level with different drugs. Design: Prospective, randomized, double-blind, controlled trial. Setting: 12 Spanish centres. Patients: A total of 119 patients with primary renal disease, blood pressure > 130/85 mmHg, proteinuria > 1 g/day, and creatinine clearance > or = 50 ml/min. Intervention: After a 4-week run-in placebo period, patients were randomized to: atenolol 50 mg/day; trandolapril 2 mg/day; verapamil 240 mg/day or verapamil 180 + trandolapril 2 mg/day combination; forced double-dose titration was carried out at the 4th week. Treatment duration was 6 months. Outcome measures: Changes in BP, 24 h proteinuria, serum albumin and calcium. Results: BP was significantly reduced with the four treatments [SBP/DBP (mmHg]: atenolol 12.2/9.9; trandolapril 12.9/9.3; verapamil 8.2/7.9 and verapamil + trandolapril 13.6/11.3) without differences between them. A significant fall in proteinuria was seen in the trandolapril, 40.2% [95% confidence interval (CI) 24.3-56.2%], and verapamil + trandolapril groups, 48.5% (95% CI, 31.7-64.3%) accompanied with increases in serum albumin (trandolapril: from 3.86 +/- 0.64 to 4.03 +/- 0.67 g/dl; verapamil + trandolapril: from 4.15 +/- 0.58 to 4.40 +/- 0.51 g/dl). Conclusions: In patients with proteinuric primary renal disease, adequate dose titration of antihypertensive drugs may provide a substantial BP reduction. Only angiotensin-converting enzyme inhibitor (trandolapril) treatment, alone or better combined with verapamil, reduces proteinuria and increases serum albumin.
ISSN: 0263-6352
DOI: 10.1097/00004872-200204000-00032
Source: Journal of Hypertension[ISSN 0263-6352],v. 20(4), p. 729-737 (Abril 2002)
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