Key result
Adding benidipine versus amlodipine to perindopril in hypertensive patients with chronic kidney disease resulted in no significant difference in the overall change of estimated glomerular filtration rate over 2 years.
Why the study?
Does combined therapy with perindopril and benidipine prevent deterioration of renal function compared to perindopril and amlodipine in hypertensive patients with chronic kidney disease?
RCT (n=121)
Table of random numbers
Yes
Does combined therapy with perindopril and benidipine prevent deterioration of renal function compared to perindopril and amlodipine in hypertensive patients with chronic kidney disease?
Absolute Event Rate: 0.83% vs -1.58%
p-value: p=0.170
In hypertensive patients with diabetic nephropathy, combining an ACE inhibitor with a T/L-type calcium channel blocker (benidipine) may better preserve renal function than an L-type calcium channel blocker (amlodipine).
May preserve eGFR better with benidipine than amlodipine in diabetic CKD on ACEI; extends CCB subclass data for renal protection.
Background: Appropriate blood pressure control suppresses progression of chronic kidney disease (CKD). If an angiotensin-converting enzyme (ACE) inhibitor is ineffective, adding a calcium antagonist is recommended. We compared the long-term effect of two ACE inhibitor/calcium antagonist combinations on renal function in hypertensive patients with CKD. Methods: Patients who failed to achieve the target blood pressure (systolic/diastolic: < 130/80 mm Hg) with perindopril monotherapy were randomized to either combined therapy with perindopril and the L-type calcium antagonist amlodipine (group A) or perindopril and the T/L type calcium antagonist benidipine (group B). The primary endpoint was the change of the estimated glomerular filtration rate (eGFR) after 2 years. Eligible patients had a systolic pressure ? 130 mm Hg and/or diastolic pressure ? 80 mm Hg and CKD (urine protein (+) or higher, eGFR < 60 min/mL/1.73 m 2 ). Results: After excluding 38 patients achieving the target blood pressure with perindopril monotherapy, 121 patients were analyzed (62 in group A and 59 in group B). Blood pressure decreased significantly in both groups, but there was no significant change of the eGFR. However, among patients with diabetes, eGFR unchanged in group B (n = 37, 59.1 ± 15.1 vs. 61.2 ± 27.9, P = 0.273), whereas decreased significantly in group A (n = 31, 57.3 ± 16.0 vs. 53.7 ± 16.7, P = 0.005). Conclusions: In hypertensive patients with diabetic nephropathy, combined therapy with an ACE inhibitor and T/L type calcium antagonist may prevent deterioration of renal function more effectively than an ACE inhibitor/L type calcium antagonist combination. J Clin Med Res. 2018;10(2):117-124 doi: https://doi.org/10.14740/jocmr3253w
No takes yet. Share an insight, caveat, or question.
Okuda et al. (2017) conducted an RCT in Hypertension with Chronic Kidney Disease (n=121). Benidipine vs. Amlodipine was evaluated on Change in estimated glomerular filtration rate (eGFR) from baseline to 2 years (mL/min/1.73 m2) (p=0.170). Adding benidipine versus amlodipine to perindopril in hypertensive patients with chronic kidney disease resulted in no significant difference in the overall change of estimated glomerular filtration rate over 2 years.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: