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Augmentation of antiproteinuric effect by combined therapy with angiotensin II receptor blocker plus calcium channel blocker in a hypertensive patient with IgA glomerulonephritis

Journal of Human Hypertension volume 16, pages 371–373 (2002)Cite this article

The majority of large-scale prospective studies have clearly shown that patients with progressive renal disease require multiple medications, preferably in addition to angiotensin-converting enzyme inhibitors (ACE-Is), in order to reach the target blood pressure.1,2,3 Recently, ang- iotensin II receptor blockers (ARBs) have been proven to possess both antihypertensive and antiproteinuric effects similar to ACE-Is.4–9 Of note is that ARBs may be advantageous to ACE-Is in that they have less incidence of coughing and mild influence on serum K concentration.10 The practical question would then be which combination as an add-on therapy, in addition to either one of the renin angiotensin system (RAS) blockers, would achieve the best outcome. In this communication, we describe a case presentation which supplied some useful data for considering the future strategy of combined treatment for renal disease with hypertension.

The last two decades have witnessed a tremendous wave of pharmacological development that has yielded numerous antihypertensive agents such as ACE-I, CCB and ARB. Soon after these agents became clinically available, many randomised prospective clinical trials were performed, and these drugs were proved to be effective in reducing blood pressure. Recently, with the overwhelming evidence that earlier and more intensive blood pressure control, preferably SBP less than 130 mm Hg, is required in patients with hypertension, it is clear that these patients are going to require multiple medications to forestall and prevent any cardiovascular complications.1,2,3 Along with this trend, a clear general consensus has been established about the usefulness of ACE-Is for retarding the decline in renal function in progressive renal disease. ACE-Is have been shown to have a substantial renoprotective effect independent of systemic blood pressure reduction.11,12 Recent clinical studies have also shown that ARBs lower blood pressure as effectively as ACE-Is. ACE-Is and ARBs also equally slow the progression of kidney disease to chronic renal failure.13,14 Thus, it should be noted that any combination therapy for progressive renal disease must include either an ACE-I or an ARB. Of note is that ARBs may be more advantageous than ACE-Is when used for patients with impaired renal function, because the resulting increase in serum K concentration is milder with the former than with the latter.10 Furthermore, ARBs may not result in an abrupt fall in Ccr at first use, whereas this may sometimes happen with ACE-Is.15 Better compliance due to absence of coughing may also be a benefit of ARBs compared with ACE-Is.

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Authors and Affiliations

  1. Division of Nephrology, Saiseikai Central Hospital, Tokyo, Japan

    S Kuriyama, H Tomonari, A Abe & T Kunieda

  2. Department of Kidney and Hypertension, Jikei University, Tokyo, Japan

    T Hosoya

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  1. S Kuriyama
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  2. H Tomonari
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  4. T Kunieda
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  5. T Hosoya
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Correspondence to S Kuriyama.

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Kuriyama, S., Tomonari, H., Abe, A. et al. Augmentation of antiproteinuric effect by combined therapy with angiotensin II receptor blocker plus calcium channel blocker in a hypertensive patient with IgA glomerulonephritis. J Hum Hypertens 16, 371–373 (2002). https://doi.org/10.1038/sj.jhh.1001324

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