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      Effect of Alpha-Adrenergic Blockers, ACE Inhibitors, and Calcium Channel Antagonists on Renal Function in Hypertensive Non-Insulin-Dependent Diabetic Patients

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          Abstract

          In the present study we investigated the effect of a selective α<sub>1</sub>-adrenergic blocker (doxazosin), an angiotensin-converting enzyme (ACE) inhibitor (captopril), and a calcium channel antagonist (nifedipine) on renal function in hypertensive non-insulin-dependent diabetic patients. 30 NIDD hypertensive patients (age = 50 ± 3 years; BMI = 30 ± 1 kg/m<sup>2</sup>) (mean ± SEM) were studied before and after a 12-week period of antihypertensive treatment. Ten patients were treated with doxazosin (Cardura) (2-8 mg once daily or 8 mg b.i.d.), 9 with captopril (Capoten) (25-50 mg b.i.d.), and 11 with nifedipine (Procardia-XL) (30-60 mg once daily). Blood pressure, creatinine clearance, 24-hour urinary protein excretion, fasting plasma glucose concentration and glycosylated hemoglobin were measured before and after drug treatment. Fasting plasma glucose and glycosylated hemoglobin (HbA<sub>1c</sub>) were similar in all three groups prior to the start of antihypertensive therapy and did not change significantly from baselline in any treatment groups. In the doxazosin group creatinine clearance rose from 99 ± 8 to 122 ± 8 ml/l.73 m<sup>2</sup>·min (p < 0.01), while 24-hour urinary protein excretion declined from 2.66 ± 0.05 to 1.76 ± 0.02 mg/day/ml/l.73 m<sup>2</sup>·min (p < 0.01). In diabetics treated with captopril creatinine clearance rose from 93 ± 6 to 109 ± 9 ml/l.73 m<sup>2</sup>·min (p < 0.05), while the 24-hour urinary protein excretion fell from 2.70 ± 0.05 to 2.03 ± 0.04 mg/ day/ml/l.73 m<sup>2</sup>·min (p < 0.05). In patients treated with nifedipine creatinine clearance did not change (97 ± 6 vs. 94 ± 7 ml/l.73 m<sup>2</sup>·min), while 24-hour urinary protein excretion decreased from 2.84 ± 0.04 to 1.95 ± 0.03 mg/day/ml/l.73 m<sup>2</sup>·min. Systolic and diastolic blood pressure were similar in doxazosin (150 ± 3/95 ± 2 mm Hg), captopril (153 ± 3 /93 ± 1), and nifedipine (155 ± 4/93 ± 1) groups prior to the start of antihypertensive therapy and declined to 143 ± 3/84 ± 3 (doxazosin), 139 ± 3/82 ± 3 (captopril), and 141 ± 3/84 ± 1 (nifedipine) mm Hg (all p < 0.01 vs. pretreatment). In summary, both doxazosin and captopril treatment were associated with significant rises in GFR, while all three antihypertensive agents caused a significant decline in proteinuria. These results indicate that α-adrenergic blockers, ACE inhibitors, and calcium channel antagonists can safely and effectively be used in the clinical management of non-insulin-dependent diabetic patients with hypertension.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          1660-8151
          2235-3186
          1996
          1996
          18 December 2008
          : 72
          : 3
          : 447-453
          Affiliations
          aDepartment of Medicine, Division of Diabetes, University of Texas Health Science Center at San Antonio, Tex., The Audie L. Murphy Veteran’s Memorial Hospital, San Antonio, Tex., USA; bThe Institute of Internal Medicine and Nephrology, Second University of Naples, Italy
          Article
          188911 Nephron 1996;72:447–453
          10.1159/000188911
          8852495
          © 1996 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 7
          Categories
          Original Paper

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