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      Effect of an α-Adrenergic Blocker, and ACE Inhibitor and Hydrochlorothiazide on Blood Pressure and on Renal Function in Type 2 Diabetic Patients with Hypertension and Albuminuria

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          Abstract

          α-Adrenergic blockers are potential alternative antihypertensive agents for diabetic patients. Data on their relative efficacy and their effect on kidney function and albuminuria are very limited however. 76 patients with diabetes type 2, hypertension (≧140/90 mm Hg) and albuminuria (≧30 mg/24 h) were randomized into three groups to receive cilazapril (2.5–10 mg), doxazosin (2–8 mg) or both. Patients of the first and second groups received a single agent for 4 months, the agents were then crossed for an additional period of 4 months followed by the addition of hydrochlorothiazide (25 mg) for a third 4-month period. Blood pressure was monitored monthly, creatinine clearance and HbA1c were measured before and at the end of each treatment period. Patients of the third group received reduced doses of cilazapril and doxazosin for 4 months. Hydrochlorothiazide was then added for the subsequent 4 months. There was a significant decline in blood pressure values during the first period in all groups. Cilazapril: systolic blood pressure (SBP) 160 ± 6 to 149 ± 5 mm Hg; diastolic blood pressure (DBP): 101 ± 3 to 94 ± 3 mm Hg (p = 0.001). Albuminuria declined from 350 ± 105 to 205 ± 96 mg/24 h (p = 0.001), creatinine clearance (CrCl) was unchanged. Doxazosin: SBP: 160 ± 7 to 151 ± 6 mm Hg; DBP: 97 ± 4 to 90 ± 4 mm Hg (p = 0.001). Albuminuria 373 ± 121 to 322 ± 107 mg/24 h (p = 0.065) and CrCl 87 ± 7 to 91 ± 6 ml/min. The combination of both agents at half doses was equipotent or superior to either drug alone. Cross-over of cilazapril and doxazosin reproduced the hypotensive effect and reversed the antialbuminuric effect. The addition of hydrochlorothiazide resulted in a further decline of 6–14 mm Hg in SBP and 3–11 mm Hg in DPB.

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          Most cited references 1

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          Which antihypertensive drugs first--and why!

           M. Alderman (1992)
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            Author and article information

            Journal
            NEF
            Nephron
            10.1159/issn.1660-8151
            Nephron
            S. Karger AG
            1660-8151
            2235-3186
            1998
            October 1998
            23 September 1998
            : 80
            : 2
            : 175-182
            Affiliations
            Department of Medicine, Sackler Faculty of Medicine, Tel-Aviv University and Meir Hospital, Kfar-Sava, Israel
            Article
            45163 Nephron 1998;80:175–182
            10.1159/000045163
            9736816
            © 1998 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
            Figures: 2, Tables: 2, References: 37, Pages: 8
            Product
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/45163
            Categories
            Original Paper

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