Usual ACE inhibitor therapy in CKD patients is associated with lower plasma aldosterone levels than usual angiotensin receptor blocker therapy.
BACKGROUND
Attenuating aldosterone (ALDO) effects may be important in slowing kidney and cardiovascular disease progression. This study tested whether ACE inhibitor (I) therapy achieves lower plasma (p) ALDO levels than angiotensin receptor blocker (ARB) therapy when they are used under usual clinical conditions in chronic kidney disease (CKD) patients.


METHODS
Consecutive CKD patients (n = 123) were studied. They were clinically stable and receiving either ACEI (n = 77) or ARB (n = 46) (physician's choice) for > or = 3 months.


RESULTS
Mean pALDO in the ACEI cohort was 7.8 +/- 5.7 (SD) ng/dl compared to 12.3 +/- 9.8 ng/dl in the ARB cohort (p = 0.0018, normal ambulatory pALDO 9.4-33.8 ng/dl). The pALDO difference was not explained by differences in age, sex, race, body weight, diagnosis of diabetes; the use of beta-blockers, calcium channel blockers or diuretic; systolic or diastolic blood pressure; plasma renin, serum creatinine, sodium, potassium, or bicarbonate levels; 24-hour urine potassium, sodium, urea or protein excretion; or ACEI or ARB dose.


CONCLUSIONS
Mean pALDO is about 60% higher with ARB therapy than ACEI therapy when these drugs are customarily used in CKD patients. This difference could be clinically important with regard to kidney and cardiovascular protection.
Haddad
Nabil
N
Department of Internal Medicine, The Ohio State University, Columbus, Ohio 43210, USA.
Rajan
James
J
Nagaraja
Haikady N
HN
Agarwal
Anil K
AK
Hebert
Lee A
LA
D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011945:Receptors, Angiotensin / Q000378:metabolism
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D011945:Receptors, Angiotensin; D000450:Aldosterone