title: Renoprotective effect and cost-effectiveness of using benidipine, a calcium channel blocker, to lower the dose of angiotensin receptor blocker in hypertensive patients with albuminuria.
abstract: In hypertensive patients with chronic renal disease, angiotensin receptor blockers (ARBs) are among the first-line drugs, and calcium channel blockers (CCBs) are recommended as a second line. We examined the effects of two therapeutic strategies using ARBs and benidipine, a CCB, on blood pressure (BP), urinary albumin excretion (UAE), and cost-effectiveness in hypertensive patients with albuminuria. Patients whose BP was 140/90 mmHg or higher despite treatment with low- or medium-dose ARBs were assigned randomly to two groups. In Group A (n=14), the ARB dose was maximized and then benidipine was added until BP targets were reached (<130/85 mmHg). In Group B (n=18), benidipine was administered first and then the ARB dose was increased until BP targets were reached. The BP targets were achieved by ARB alone in 36% of Group A patients and by the addition of benidipine in 83% of Group B patients. Finally, BP decreased in each group, reaching the targets in 93% of Group A patients and 94% of Group B patients after a 4-month therapeutic period. UAE was decreased in both groups after a 4-month therapeutic period compared to the allocation period (-33+/-6% in Group A, -31+/-6% in Group B; p<0.001, respectively). The monthly drug cost was higher (11,426+/-880 vs. 8,955+/-410 yen, p=0.012) and the cost-effectiveness of antihypertensive treatment was lower (p=0.003) in Group A than in Group B. We conclude that the addition of benidipine to low- or medium-dose ARB is, in light of the renal protection and the cost-effectiveness of this approach, a useful therapeutic strategy for controlling BP in hypertensive patients with albuminuria.
authors: Department of Cardiology, Nihon University Surugadai Hospital, Tokyo, Japan.
authors: Fumio
authors: F
authors: Saito
authors: Hirotaka
authors: H
authors: Fujita
authors: Atsuhiko
authors: A
authors: Takahashi
authors: Izumi
authors: I
authors: Ichiyama
authors: Shinsuke
authors: S
authors: Harasawa
authors: Kouji
authors: K
authors: Oiwa
authors: Naoyuki
authors: N
authors: Takahashi
authors: Yuji
authors: Y
authors: Otsuka
authors: Takashi
authors: T
authors: Uchiyama
authors: Katsuo
authors: K
authors: Kanmatsuse
authors: Toshio
authors: T
authors: Kushiro
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004095:Dihydropyridines / Q000191:economics* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D007668:Kidney / Q000187:drug effects*; D008297:Male; D008875:Middle Aged
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D002121:Calcium Channel Blockers; D004095:Dihydropyridines; C061004:benidipine