Verapamil reverts acute renal functional impairment induced by angiotensin II converting enzyme inhibitors.
Angiotensin converting enzyme inhibitors (ACEI) reduce blood pressure (BP) and provide end-organ protection, but may induce renal function deterioration. In these cases, serum creatinine (SCr) can be normalized by ACEI withdrawn. In some patients, it could be desirable to maintain the ACEI for the protection of the kidney and heart. The objective of the study was to evaluate the effect of Verapamil (V) on renal function added to patients with elevated SCr due to ACEI treatment. In 46 hypertensive patients without previous renal failure, in which ACEI treatment induced an acute increase in SCr (> or = 20% or 0.5 mg/dL), ACEI treatment was maintained and 180 mg/day of V was added for 12 weeks. Those patients showing further SCr increase or no BP control at four weeks were withdrawn. Patients under BP control were moved on the combination V 180 + Trandolapril 2 mg/day for eight weeks more. SCr decreased from 136 +/- 49 micromol/L at baseline to 126 +/- 49 at 12 weeks after adding V (p < 0.001) and to 111 +/- 31 micromol/L at 20 weeks (p < 0.01). Creatinine clearance increased from 62 +/- 22 mL/min at baseline to 68 +/- 28 after 12 weeks of V (p < 0.001). This article demonstrates than in patients with acute renal function impairment secondary to ACEI treatment, the addition of 180 mg/day of verapamil to ACEI reverses SCr towards previous values.
Unidad de Hipertensión, Hospital Universitario de Salamanca, Instituto Reina Sofia de Investigación Nefrológica, Salamanca, Spain. jfmacias@usal.es
Juan F
JF
Macías-Núñez
Raul
R
Fernández
Carlos
C
Calvo
Jesus
J
Grande
Julio
J
Herrera
Jesus
J
Bustamante
Ricardo
R
Garay
Ricardo
R
Robles
José M
JM
López-Novoa
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000188:drug therapy*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000494:pharmacology; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D004336:Drug Antagonism; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007211:Indoles / Q000009:adverse effects* / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014700:Verapamil / Q000494:pharmacology / Q000627:therapeutic use*
D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D007211:Indoles; C052035:trandolapril; D003404:Creatinine; D014700:Verapamil