What question did this study set out to answer?

To evaluate the effects of hydrochlorothiazide alone versus combined with enalapril, losartan, or both on renal hemodynamics, glomerular dynamics, and kidney injury in hypertensive rats.

May 18, 2005AJP Renal Physiology

Superiority of combination of thiazide with angiotensin-converting enzyme inhibitor or AT₁-receptor blocker over thiazide alone on renoprotection inl-NAME/SHR

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Why the study?

Does the combination of HCTZ with enalapril and/or losartan improve renoprotection compared to HCTZ alone in the l-NAME/SHR model?

Key Points

To evaluate the effects of hydrochlorothiazide alone versus combined with enalapril, losartan, or both on renal hemodynamics, glomerular dynamics, and kidney injury in hypertensive rats.
Administered hydrochlorothiazide (80 mg/kg/day) alone or with enalapril (30 mg/kg/day), losartan (30 mg/kg/day), or both (15 mg/kg/day each) for 3 weeks to L-NAME-treated spontaneously hypertensive rats.
Measured systemic blood pressure, peripheral resistance, renal plasma flow, glomerular filtration rate, glomerular pressures and resistances, serum creatinine, proteinuria, and histological injury scores.
Hydrochlorothiazide monotherapy significantly lowered mean arterial pressure, total peripheral resistance, glomerular hydrostatic pressure, and arteriolar resistances (P < 0.05), with modest improvements in renal plasma flow, proteinuria, and creatinine.
Combining hydrochlorothiazide with enalapril, losartan, or both markedly enhanced renal hemodynamics, reduced glomerular and arteriolar injury scores, and demonstrated superior renoprotection compared to hydrochlorothiazide alone.

Structured PICO

Does the combination of HCTZ with enalapril and/or losartan improve renoprotection compared to HCTZ alone in the l-NAME/SHR model?

Population

N(omega)-nitro-l-arginine methyl ester-treated spontaneously hypertensive rat (l-NAME/SHR) model

Intervention

Hydrochlorothiazide (HCTZ) 80 mg/kg/day in combination with enalapril (30 mg/kg/day) or losartan (30 mg/kg/day) or enalapril (15 mg/kg/day) plus losartan (15 mg/kg/day) for 3 weeks

Comparator

HCTZ 80 mg/kg/day alone and l-NAME/SHR control

Outcome

Renal hemodynamics, glomerular dynamics, renal function, and renal histopathology (including mean arterial pressure, total peripheral resistance, renal plasma flow, glomerular filtration rate, glomerular hydrostatic pressure, afferent and efferent glomerular arteriolar resistances, single nephron plasma flow, single nephron glomerular filtration rate, serum creatinine concentration, 24-h urinary protein excretion, and glomerular and arteriolar injury scores)surrogate

The combination of HCTZ with an ACE inhibitor or ARB provides superior renoprotection compared to HCTZ monotherapy in a hypertensive rat model.

Discussion

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Implication

Supports additive renoprotection with ACEI/ARB plus HCTZ in hypertensive rats; leaves open translation to human CKD.

Cite This Study

Zhou et al. (2005) studied this question.

synapsesocial.com/papers/6a714675e5469ee92be1d9d8 https://doi.org/10.1152/ajprenal.00129.2005

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Superiority of combination of thiazide with angiotensin-converting enzyme inhibitor or AT₁-receptor blocker over thiazide alone on renoprotection inl-NAME/SHR

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Superiority of combination of thiazide with angiotensin-converting enzyme inhibitor or AT₁-receptor blocker over thiazide alone on renoprotection inl-NAME/SHR

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Also Consider