What does this research mean for the field?

Losartan significantly reduces proteinuria in patients with chronic kidney disease and hypertension compared to amlodipine, providing renoprotective benefits that are independent of the magnitude of blood pressure control. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2004Open Access

Renoprotective Effect of Losartan in Comparison to Amlodipine in Patients with Chronic Kidney Disease and Hypertension-a Report of the Japanese Losartan Therapy Intended for the Global Renal Protection Hypertensive Patients (JLIGHT) Study

PICO estructurado

Does losartan reduce proteinuria compared to amlodipine in patients with chronic kidney disease and hypertension?

Población

117 outpatients (aged 20-74 years) with proteinuric chronic kidney disease (CKD) and hypertension. Key inclusion criteria: serum creatinine 1.5-3.0 mg/dl (males ≥60kg) or 1.3-3.0 mg/dl (females/males <60kg); SBP ≥140 mmHg or DBP ≥90 mmHg; urinary protein excretion ≥0.5 g/day. Diagnoses included chronic glomerulonephritis (n=79), diabetic nephropathy (n=14), and other CKD (n=24).

Intervención

Losartan 25 mg to 100 mg oral once daily (or 50 mg starting dose if compliance judged good). Target BP <130/85 mmHg. Antihypertensive combination therapy allowed after 3 months if target not met.

Comparador

Amlodipine 2.5 mg to 5 mg oral once daily (or 5 mg starting dose if compliance judged good). Target BP <130/85 mmHg. Antihypertensive combination therapy allowed after 3 months if target not met.

Resultado

Change in 24-h urinary protein excretion at 12 monthssurrogate

Losartan reduces proteinuria in patients with chronic kidney disease and hypertension, providing a renoprotective benefit that extends beyond its blood pressure-lowering effects.

Resumen

A 12-month, multicenter (57 clinical institutions), randomized, open-labeled trial was undertaken to compare the efficacy of the angiotensin II receptor antagonist losartan and the calcium channel blocker amlodipine in patients with proteinuric chronic kidney disease (CKD) and hypertension. A total of 117 patients (79, chronic glomerulonephritis; 14, diabetic nephropathy; 24, other CKD) were randomly allocated into two treatment groups. Losartan and amlodipine exerted the same efficacy for blood pressure (BP) control; however, losartan significantly reduced the 24-h urinary protein excretion at months 3, 6, and 12, with the reduction of 20.7%, 35.2%, 35.8%, whereas amlodipine did not change the amount of proteinuria over the 12-month study period. When patients were stratified into groups according to the level of BP control at 3 months, the reduction in urinary protein excretion by losartan was evident in the group for which a BP of or = 2 g/day showed a reduction in proteinuria by losartan of 23.3%, 39.4%, and 47.9% at months 3, 6, and 12, and those with <2 g/day showed a reduction of 18.5% and 31.2% at months 3 and 6, respectively. No fatal adverse events were experienced in either drug group. We conclude that losartan reduced proteinuria in patients with CKD and hypertension. This positive effect may contribute to the renal protective benefit of losartan, and is beyond the magnitude of BP control.

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