Optimal antiproteinuric dose of losartan in nondiabetic patients with nephrotic range proteinuria.
Although the antiproteinuric response to antihypertensive treatment is the main predictor of renoprotective efficacy in long-term renal disease, to date, dose-finding studies of antihypertensives have been based only on blood pressure. We aimed to find the optimal antiproteinuric dose of the angiotensin II antagonist losartan. An open-label, dose-response study using subsequent 6-week treatment periods was performed in 10 nondiabetic patients with proteinuria of 5.8 +/- 0.8 g/d and a mean arterial pressure of 103 +/- 3.7 mm Hg without antihypertensive medication. All patients had normal to moderately impaired renal function. After the baseline period, five periods followed with a daily losartan dose of 50 mg, 100 mg, 150 mg, and 50 mg and a recovery without losartan. At the end of each period, proteinuria and mean arterial pressure were measured. The consecutive doses of losartan had a similar antihypertensive response (-11.3 +/- 2.8% by the 100-mg dose). The optimal antiproteinuric response was reached at 100 mg of losartan (-30 +/- 8%). The 50-mg dose (-13 +/- 7%) was less effective, and the 150-mg dose (-28 +/- 8%) was not more effective. A 100-mg dose of losartan is optimal for reduction of proteinuria in nondiabetic patients with nephrotic range proteinuria.
Laverman
G D
GD
Department of Medicine, Division of Nephrology, Groningen University Institute for Drug Exploration (GUIDE), Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands. G.D.laverman@int.azg.nl
Henning
R H
RH
de Jong
P E
PE
Navis
G
G
de Zeeuw
D
D
D000959:Antihypertensive Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D006801:Humans; D019808:Losartan / Q000008:administration & dosage*; D011446:Prospective Studies; D011507:Proteinuria / Q000188:drug therapy*
D000959:Antihypertensive Agents; D019808:Losartan