A random comparison of fosinopril and nifedipine GITS in patients with primary renal disease

OBJECTIVE: To investigate in a random comparison the capacity of an angiotensin converting enzyme inhibitor (fosinopril), and that of a long-acting dihydropiridine (nifedipine GITS) to modify the decay in renal function in patients with primary renal disease, exhibiting a progressive increase in ser...

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Authors: Marin, R. (Rafael)|||/items/894f5c32-0c86-4b7f-879f-7db7e79cca07, Ruilope, L.M. (Luis M.)|||/items/98ab96f7-936a-45b3-928c-7f8f5a32f05a, Aljama, P. (P.)|||/items/95645ced-063e-4fb9-bf1d-8ebf3f9728b0, Aranda, P. (P.)|||/items/92ca618c-acbf-4ecc-99dc-498fe5af2078, Segura, J. (Julián)|||/items/326afa1b-8edb-4d8b-8d9d-7ca7a04d9aeb, Diez-Martinez, J. (Javier)|||/items/4f3a0e43-12bf-403d-9dc7-31fab0d11d41
Format: article
Publication Date:2001
Country:España
Institution:Universidad de Navarra
Repository:Dadun. Depósito Académico Digital de la Universidad de Navarra
Language:English
OAI Identifier:oai:dadun.unav.edu:10171/19909
Online Access:https://hdl.handle.net/10171/19909
Access Level:Open access
Keyword:Calcium channel blockers
Chronic renal failure
Converting
Creatinine clearance
Fosinopril
Nifedipine GITS
Proteinuria
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spelling A random comparison of fosinopril and nifedipine GITS in patients with primary renal diseaseMarin, R. (Rafael)|||/items/894f5c32-0c86-4b7f-879f-7db7e79cca07Ruilope, L.M. (Luis M.)|||/items/98ab96f7-936a-45b3-928c-7f8f5a32f05aAljama, P. (P.)|||/items/95645ced-063e-4fb9-bf1d-8ebf3f9728b0Aranda, P. (P.)|||/items/92ca618c-acbf-4ecc-99dc-498fe5af2078Segura, J. (Julián)|||/items/326afa1b-8edb-4d8b-8d9d-7ca7a04d9aebDiez-Martinez, J. (Javier)|||/items/4f3a0e43-12bf-403d-9dc7-31fab0d11d41Calcium channel blockersChronic renal failureConvertingCreatinine clearanceFosinoprilNifedipine GITSProteinuriaOBJECTIVE: To investigate in a random comparison the capacity of an angiotensin converting enzyme inhibitor (fosinopril), and that of a long-acting dihydropiridine (nifedipine GITS) to modify the decay in renal function in patients with primary renal disease, exhibiting a progressive increase in serum creatinine during the previous 2 years. METHODS: A randomized, open-label, multicenter study with a minimum follow-up of 3 years. A total of 241 patients were included in the study. All of them were hypertensive and had a 25% or at least 0.5 mg/dl increase in the value of serum creatinine during the 24 months prior to entering the study. Initial doses of fosinopril and nifedipine GITS were 10 and 30 mg respectively, and titration to 30 and 60 mg was performed if needed to obtain the expected blood pressure goal (< 140/90 mmHg). Furosemide, atenolol, and doxazosin were added as second, third, and fourth drugs if necessary, for blood pressure control. The primary end-point of the study was the appearance of double the serum creatinine values and/or the need to enter a dialysis programme. Secondary end-points were cardiovascular events, death, changes in 24 h proteinuria, and the evolution of serum creatinine. Data reflect the analysis performed by intention to treat. RESULTS: Mean age of the group was 54 +/- 14, and 59% were males. Primary glomerulonephritis (31%), nephrosclerosis (26%) and polycystic kidney disease (19%) were the three most frequent diagnostic findings. After 3 years of follow-up, 21% (27/127) of patients treated with fosinopril, and 36% (40/112) of those receiving nifedipine GITS presented a primary end-point, (OR 0.47, 95% confidence intervals 0.26-0.84, P = 0.01). Renal survival was significantly better when fosinopril constituted the first step therapy (P = 0.002). These results did not seem to be influenced by the type of primary renal disease. Proteinuria decreased at the end of the study by a mean of 57% in the fosinopril group and increased by 7% in the group receiving dihydropiridine. Blood pressure control did not differ among groups for diastolic values. During follow-up, however, the patients receiving ACEi showed systolic blood pressure values 4-6 mmHg lower. CONCLUSION: In patients with chronic renal failure and hypertension due to primary renal disease, fosinopril significantly differed from nifedipine GITS by its capacity to slow the progressive decay in renal function. The drugs also differed by their capacity to lower blood pressure. The better control, in particular of systolic blood pressure, in the fosinopril arm could have contributed in a relevant manner to the attainment of a better outcome when the ACEi was employed.Lippincott, Williams & WilkinsDadun. Depósito Académico Digital Universidad de Navarra20112011-11-2320012001-01-0120012001-01-01journal articlehttp://purl.org/coar/resource_type/c_6501info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/10171/19909reponame:Dadun. Depósito Académico Digital de la Universidad de Navarrainstname:Universidad de NavarraInglésengopen accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:dadun.unav.edu:10171/199092026-06-21T12:47:57Z
dc.title.none.fl_str_mv A random comparison of fosinopril and nifedipine GITS in patients with primary renal disease
title A random comparison of fosinopril and nifedipine GITS in patients with primary renal disease
spellingShingle A random comparison of fosinopril and nifedipine GITS in patients with primary renal disease
Marin, R. (Rafael)|||/items/894f5c32-0c86-4b7f-879f-7db7e79cca07
Calcium channel blockers
Chronic renal failure
Converting
Creatinine clearance
Fosinopril
Nifedipine GITS
Proteinuria
title_short A random comparison of fosinopril and nifedipine GITS in patients with primary renal disease
title_full A random comparison of fosinopril and nifedipine GITS in patients with primary renal disease
title_fullStr A random comparison of fosinopril and nifedipine GITS in patients with primary renal disease
title_full_unstemmed A random comparison of fosinopril and nifedipine GITS in patients with primary renal disease
title_sort A random comparison of fosinopril and nifedipine GITS in patients with primary renal disease
dc.creator.none.fl_str_mv Marin, R. (Rafael)|||/items/894f5c32-0c86-4b7f-879f-7db7e79cca07
Ruilope, L.M. (Luis M.)|||/items/98ab96f7-936a-45b3-928c-7f8f5a32f05a
Aljama, P. (P.)|||/items/95645ced-063e-4fb9-bf1d-8ebf3f9728b0
Aranda, P. (P.)|||/items/92ca618c-acbf-4ecc-99dc-498fe5af2078
Segura, J. (Julián)|||/items/326afa1b-8edb-4d8b-8d9d-7ca7a04d9aeb
Diez-Martinez, J. (Javier)|||/items/4f3a0e43-12bf-403d-9dc7-31fab0d11d41
author Marin, R. (Rafael)|||/items/894f5c32-0c86-4b7f-879f-7db7e79cca07
author_facet Marin, R. (Rafael)|||/items/894f5c32-0c86-4b7f-879f-7db7e79cca07
Ruilope, L.M. (Luis M.)|||/items/98ab96f7-936a-45b3-928c-7f8f5a32f05a
Aljama, P. (P.)|||/items/95645ced-063e-4fb9-bf1d-8ebf3f9728b0
Aranda, P. (P.)|||/items/92ca618c-acbf-4ecc-99dc-498fe5af2078
Segura, J. (Julián)|||/items/326afa1b-8edb-4d8b-8d9d-7ca7a04d9aeb
Diez-Martinez, J. (Javier)|||/items/4f3a0e43-12bf-403d-9dc7-31fab0d11d41
author_role author
author2 Ruilope, L.M. (Luis M.)|||/items/98ab96f7-936a-45b3-928c-7f8f5a32f05a
Aljama, P. (P.)|||/items/95645ced-063e-4fb9-bf1d-8ebf3f9728b0
Aranda, P. (P.)|||/items/92ca618c-acbf-4ecc-99dc-498fe5af2078
Segura, J. (Julián)|||/items/326afa1b-8edb-4d8b-8d9d-7ca7a04d9aeb
Diez-Martinez, J. (Javier)|||/items/4f3a0e43-12bf-403d-9dc7-31fab0d11d41
author2_role author
author
author
author
author
dc.contributor.none.fl_str_mv Dadun. Depósito Académico Digital Universidad de Navarra
dc.subject.none.fl_str_mv Calcium channel blockers
Chronic renal failure
Converting
Creatinine clearance
Fosinopril
Nifedipine GITS
Proteinuria
topic Calcium channel blockers
Chronic renal failure
Converting
Creatinine clearance
Fosinopril
Nifedipine GITS
Proteinuria
description OBJECTIVE: To investigate in a random comparison the capacity of an angiotensin converting enzyme inhibitor (fosinopril), and that of a long-acting dihydropiridine (nifedipine GITS) to modify the decay in renal function in patients with primary renal disease, exhibiting a progressive increase in serum creatinine during the previous 2 years. METHODS: A randomized, open-label, multicenter study with a minimum follow-up of 3 years. A total of 241 patients were included in the study. All of them were hypertensive and had a 25% or at least 0.5 mg/dl increase in the value of serum creatinine during the 24 months prior to entering the study. Initial doses of fosinopril and nifedipine GITS were 10 and 30 mg respectively, and titration to 30 and 60 mg was performed if needed to obtain the expected blood pressure goal (< 140/90 mmHg). Furosemide, atenolol, and doxazosin were added as second, third, and fourth drugs if necessary, for blood pressure control. The primary end-point of the study was the appearance of double the serum creatinine values and/or the need to enter a dialysis programme. Secondary end-points were cardiovascular events, death, changes in 24 h proteinuria, and the evolution of serum creatinine. Data reflect the analysis performed by intention to treat. RESULTS: Mean age of the group was 54 +/- 14, and 59% were males. Primary glomerulonephritis (31%), nephrosclerosis (26%) and polycystic kidney disease (19%) were the three most frequent diagnostic findings. After 3 years of follow-up, 21% (27/127) of patients treated with fosinopril, and 36% (40/112) of those receiving nifedipine GITS presented a primary end-point, (OR 0.47, 95% confidence intervals 0.26-0.84, P = 0.01). Renal survival was significantly better when fosinopril constituted the first step therapy (P = 0.002). These results did not seem to be influenced by the type of primary renal disease. Proteinuria decreased at the end of the study by a mean of 57% in the fosinopril group and increased by 7% in the group receiving dihydropiridine. Blood pressure control did not differ among groups for diastolic values. During follow-up, however, the patients receiving ACEi showed systolic blood pressure values 4-6 mmHg lower. CONCLUSION: In patients with chronic renal failure and hypertension due to primary renal disease, fosinopril significantly differed from nifedipine GITS by its capacity to slow the progressive decay in renal function. The drugs also differed by their capacity to lower blood pressure. The better control, in particular of systolic blood pressure, in the fosinopril arm could have contributed in a relevant manner to the attainment of a better outcome when the ACEi was employed.
publishDate 2001
dc.date.none.fl_str_mv 2001
2001-01-01
2001
2001-01-01
2011
2011-11-23
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/10171/19909
url https://hdl.handle.net/10171/19909
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Lippincott, Williams & Wilkins
publisher.none.fl_str_mv Lippincott, Williams & Wilkins
dc.source.none.fl_str_mv reponame:Dadun. Depósito Académico Digital de la Universidad de Navarra
instname:Universidad de Navarra
instname_str Universidad de Navarra
reponame_str Dadun. Depósito Académico Digital de la Universidad de Navarra
collection Dadun. Depósito Académico Digital de la Universidad de Navarra
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,300719

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