November 19, 2008Cardiology
Renal Protection in Diabetes-An Emerging Role for Calcium Antagonists
Why the study?
Do long-acting calcium antagonists preserve kidney function and prevent the progression of nephropathy in hypertensive diabetic patients?
Population
Diabetic patients with hypertension and incipient or overt diabetic nephropathy
Comparison
Calcium antagonists vs Angiotensin-converting-enzyme inhibitors or…
Design
Review
Authors
Discussion
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Implication
May support long-acting calcium antagonists for renal protection in hypertensive diabetic nephropathy; leaves open first-line preference versus ACE inhibitors pending confirmatory trials.
Key Points
- To evaluate the role of calcium antagonists in renal protection among diabetic patients with nephropathy.
- Conducted a 1-year randomized double-blind study in hypertensive insulin-dependent diabetic patients with nephropathy.
- Performed a 5-year randomized open study in hypertensive noninsulin-dependent diabetic patients with nephropathy.
- Compared effects of calcium antagonists and ACE inhibitors on kidney function.
- Nisoldipine showed a more beneficial effect on glomerular filtration rate decline than ACE inhibition (exact metrics not provided).
- Mean arterial blood pressure was similar in both treatment groups (103 and 101 mm Hg).
- Less than 10% of patients with calcium antagonists or ACE inhibitors experienced a doubling of creatinine compared to over 50% with sympatholytic drugs.
Structured PICO
Do long-acting calcium antagonists preserve kidney function and prevent the progression of nephropathy in hypertensive diabetic patients?
P
Population
Diabetic patients with hypertension and incipient or overt diabetic nephropathy
I
Intervention
Calcium antagonists (specifically long-acting dihydropyridines such as nisoldipine)
C
Comparator
Angiotensin-converting-enzyme (ACE) inhibitors or sympatholytic drugs
O
Outcome
Decline rate in glomerular filtration rate and progression of nephropathysurrogate
Long-acting calcium antagonists may offer comparable renal protection to ACE inhibitors in hypertensive patients with diabetic nephropathy, highlighting their emerging role in this high-risk population.
Limitations
- Lack of long-term trials using new long-acting dihydropyridine calcium antagonists for incipient nephropathy
- Need for long-term studies to consolidate findings in insulin-dependent diabetic patients with diabetic kidney disease
Cite This Study
Parving et al. (2008) studied this question.