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Effects of up-titration of candesartan versus candesartan plus amlodipine on kidney function in type 2 diabetic patients with albuminuria

Journal of Human Hypertension volume 26, pages 214–219 (2012)Cite this article

Abstract

In the present study, we tested the hypothesis that up-titrating the dose of an angiotensin receptor blocker (ARB) is superior to combined treatment with an ARB and a calcium channel blocker for the same degree of blood pressure (BP) reduction, with respect to urinary albumin excretion in diabetic patients treated with a standard dose of the ARB. Hypertensive patients with type 2 diabetes mellitus and albuminuria (⩾30 mg g−1 creatinine) were enroled in the study, and were either started on or switched to candesartan (8 mg per day) monotherapy. After a 12-week run-in period, baseline evaluations were performed and patients with BP ⩾130/80 mm Hg were randomly assigned to receive either candesartan (12 mg per day) or candesartan (8 mg per day) plus amlodipine (2.5 mg per day) for a further 12 weeks. The primary end-point was a reduction in urinary albumin levels. Although there was no significant difference in the BP reduction between the two groups, the reduction in urinary albumin was greater in the up-titrated than the combination therapy group (−40±14% vs −9±38%, respectively; P<0.0001). Thus, up-titration of candesartan more effectively reduces urinary albumin excretion than combined candesartan plus amlodipine in hypertensive patients with diabetes for the same degree of BP reduction.

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Authors and Affiliations

  1. Department of Internal Medicine, Oyamada Memorial Spa Hospital, Yokkaichi, Japan

    T Okura

  2. Department of Internal Medicine, Komono Kosei Hospital, Komono, Japan

    M Kojima

  3. Department of Internal Medicine, Yamamoto General Hospital, Kuwana, Japan

    H Machida, T Ichikawa & K Nakatani

  4. Department of Cardiology, Inabe General Hospital, Inabe, Japan

    M Sugiyama

  5. Kato Physician’s Office, Kuwana, Japan

    T Kato

  6. Dr Komada’s Office, Tsu, Japan

    T Komada

  7. Department of Internal Medicine, Tsu Seikyo Hospital, Tsu, Japan

    T Miyazaki

  8. Department of Internal Medicine, Ninomiya Hospital, Yokkaichi, Japan

    T Ninomiya

  9. Watanabe Clinic, Tsu, Japan

    Y Watanabe

  10. Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    Y Dohi & G Kimura

  11. Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan

    M Ito

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Correspondence to Y Dohi.

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Okura, T., Kojima, M., Machida, H. et al. Effects of up-titration of candesartan versus candesartan plus amlodipine on kidney function in type 2 diabetic patients with albuminuria. J Hum Hypertens 26, 214–219 (2012). https://doi.org/10.1038/jhh.2011.22

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  • DOI: https://doi.org/10.1038/jhh.2011.22

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