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      Angiotensin II Type 1 Receptor Antagonist, Losartan, Causes Regression of Left Ventricular Hypertrophy in End-Stage Renal Disease

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          Left ventricular hypertrophy (LVH) commonly occurs in patients with end-stage renal disease (ESRD) and is an independent risk factor for cardiovascular events. Angiotensin II type 1 receptor (AT1-R) antagonists may be able to reverse LVH independent to the hypotensive effect in the ESRD setting. Thirty chronically hemodialyzed uremic patients with hypertension were randomly assigned to receive the AT1-R antagonist losartan (n = 10), the angiotensin-converting enzyme (ACD) inhibitor enalapril (n = 10), or calcium antagonist amlodipine (n = 10). Left ventricular mass (LVM) index was measured by echocardiography before and 6 months after treatment. The baseline demographic and clinical characteristics did not differ between the three groups. The mean baseline LVM index also did not differ in the three groups. After 6 months of treatment, losartan treatment significantly reduced the LVM index (–24.7 ± 3.2%) than amlodipine (–10.5 ± 5.2%) or enalapril (–11.2 ± 4.1%) therapy. All three groups had a similar decrease in the mean blood pressure with treatment. The plasma angiotensin II concentration increased 5-fold with losartan treatment. In contrast, the plasma angiotension II concentration did not change with enalapril and only increased 2-fold with amlodipine. Thus, the present study indicates that losartan more effectively regresses LVH in patients with ESRD than do enalapril and amlodipine despite a comparable depressor effect between the three drugs.

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          Interaction between hypertension and other cardiovascular risk factors in survival of hemodialyzed patients.

          The interaction of hypertension with other cardiovascular risk factors, namely hypercholesterolemia, smoking, and past history of cardiovascular complications, was examined. One hundred and ninety-five hemodialysis patients were followed up for 54.2 +/- 2.3 months, among whom 66 died. In patients with cardiovascular complications, such as ischemic heart disease, cerebrovascular accident, or atherosclerotic obliteration of peripheral arteries, and in patients older than 70 years, blood pressure had no significant effect on the already poor survival. On the other hand, in patients with hypercholesterolemia (> or = 220 mg/dL) and in smokers, elevated systolic blood pressure made the survival significantly worse. These results suggest an interaction between hypertension and other cardiovascular risk factors in hemodialysis patients.
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            Effect of danaparoid sodium on hard exudates in diabetic retinopathy.

            In diabetes mellitus, both retinopathy and nephropathy represent specific microvascular disease with increased capillary permeability resulting in hard exudates, foveal oedema, and albuminuria. The decrease of heparan-sulphate content of the glomerular-basement membrane is quantitatively related to the rate of proteinuria in nephropathy associated with insulin-dependent diabetes mellitus (IDDM). Several short-term studies in patients with IDDM and non-IDDM have shown that a reduction of microalbuminuria and macroalbuminuria can be achieved with the supplementation of glycosaminoglycans. After completion of a study on the effect of danaparoid sodium on albumin excretion in patients with IDDM and macroalbuminuria, we hypothesised that treatment with danaparoid sodium also influenced retinal leakage in the patients in that trial. In this retrospective study nine patients with nephropathy received 750 anti-Xa units danaparoid sodium once a day for 6 weeks in a placebo-controlled double-blind cross-over study. Fundus photographs, done at baseline and at the end of the study, were semiquantitatively scored for the severity of hard exudates. At baseline 14 eyes had grade 1 to 5 severity of hard exudates and four eyes were without hard exudates (grade 0). There was no progression in the latter four eyes. In ten eyes an improvement was observed: four patients showed a favourable response to treatment in both eyes and two patients showed improvement in one eye. We found improvement of hard exudates after 6 weeks of treatment with danaparoid sodium. Our uncontrolled observation indicates that the supplementation of danaparoid sodium influences both the permeability of retinal vessels as well as of glomerular vessels. Danaparoid-sodium therapy as a systemic adjuvant is worth considering for treatment strategies for foveal oedema and hard exudates in diabetic maculopathy.

              Author and article information

              S. Karger AG
              March 2002
              25 February 2002
              : 90
              : 3
              : 256-261
              Department of Medicine II, Kansai Medical University, Moriguchi, Osaka, Japan
              49060 Nephron 2002;90:256–261
              © 2002 S. Karger AG, Basel

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              Page count
              Figures: 2, Tables: 2, References: 35, Pages: 6
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/49060
              Original Paper


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