title: Effects of ramipril and valsartan on proteinuria and renal function in patients with nondiabetic proteinuria.
abstract: The renin-angiotensin system is involved in the progression of chronic renal disease of both diabetic and nondiabetic origin. The angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers have been demonstrated to reduce urinary protein excretion and attenuate the development of renal injury. This prospective, randomized, 12-month study assessed the effects of ramipril (N = 23) vs. valsartan (N = 22) vs. combination of ramipril and valsartan (N = 26) on proteinuria, renal function and metabolic profile in 71 patients with nondiabetic proteinuria with normal or slightly impaired renal function. Monotherapy with ramipril or valsartan and combination of these two drugs significantly reduced proteinuria, serum creatinine, cholesterol and triglycerides as well as systolic and diastolic arterial blood pressure. There was no significant difference among three study groups according to reduction of arterial blood pressure, serum cholesterol and triglycerides. At one year, a significant reduction in serum creatinine was recorded in all three study groups, whereas at 3 and 6 months a statistically significant reduction in serum creatinine was only observed in patients on combination therapy. In addition, at 3 months the reduction of proteinuria was significantly greater in patients on combination therapy than in those on either monotherapy. These results indicated the combination therapy with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers to be more efficacious than either monotherapy in reducing proteinuria and serum creatinine level in the first 3 (proteinuria and serum creatinine) or 6 (serum creatinine) months of treatment.
authors.affiliation: University of Zagreb, Dubrava University Hospital, Department of Nephrology, Zagreb, Croatia.
authors.forename: Marija
authors.initials: M
authors.lastname: Bilić
authors.forename: Radenka
authors.initials: R
authors.lastname: Munjas-Samarin
authors.forename: Danica
authors.initials: D
authors.lastname: Ljubanović
authors.forename: Ivica
authors.initials: I
authors.lastname: Horvatić
authors.forename: Kresimir
authors.initials: K
authors.lastname: Galesić
mesh_terms: D000328:Adult; D000368:Aged; D057912:Angiotensin II Type 2 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D008875:Middle Aged; D011446:Prospective Studies; D011507:Proteinuria / Q000188:drug therapy* / Q000503:physiopathology; D017257:Ramipril / Q000627:therapeutic use*; D013777:Tetrazoles / Q000627:therapeutic use*; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D057912:Angiotensin II Type 2 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D013777:Tetrazoles; D000068756:Valsartan; D003404:Creatinine; D014633:Valine; D017257:Ramipril