Discussion panel of/Panel de discusión de Blood pressure control and proteinuria reduction in primary renal disease


Blood pressure control and proteinuria reduction in primary renal disease

Javier Nieto Iglesias, Luis M. Ruilope Urioste, Soledad García de Vinuesa, Dolores Jarillo Ibáñez, José Mora-Maciá, José C. Rodríguez-Pérez, Ramón Romero, Pedro Aljama, Florencio García-Martín, Alfonso Pérez-García, Raúl Fernández and Jesús Garrido,

PROCOPA Study Group. Spain.

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Dear Dr. Iglesias,
your data regarding ACE-inhibitors in glomerulonephritis are in accordance with
the general impression that this medication can symptomatically lower proteinuria.
However, we found that other blood pressure lowering medications do also lower
proteinuria. In a Latin-square designed clinical study [Celiprolol
(beta-1-antagonist, beta-2-agonist, 200 mg/d), Atenolol
(selective beta-1-antagonist, 50 mg/d), Ramipril (ACE-inhibitor, 2.5 mg/d)
and placebo] all three drugs significantly reduced proteinuria (P < 0.05):
1.8 +/- 1.3 g/24 h with placebo, 1.2 +/- 1.2 g/24 h with atenolol,
1.2 +/- 1.1 g/24 h with celiprolol and 1.4 +/- 1.4 g/24 h with ramipril, compared
to placebo.
Thus, may I ask you for further information about the type of glomerular disease in
your four groups and whether all groups were similar with respect to initial
blood pressure and the presence of tubulo-interstitial fibrosis?

Norbert Braun

Interesting results. Why does albumin only increase in the group treated with verapamil as well (proteinuria decrease is alike to the ACEI alone group)?

On the calcium issue, I am afraid that the observed increase in calcium is NOT related to the use of verapamil but a consequence of the increased albumin. Did you correct the figures of total calcium by albumin or protein? It might be an spurious effect of protein concentration...if not so....what happened to PTH levels??

Jordi Bover

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