title: Kidney-protective effects of azelnidipine versus a diuretic in combination with olmesartan in hypertensive patients with diabetes and albuminuria: a randomized study.
abstract: BACKGROUND
  A thiazide diuretic used in combination with benazepril is superior to amlodipine plus benazepril in reducing albuminuria in hypertensive patients with diabetes. However, calcium channel blockers have diverse characteristics. Thus, we investigated whether combining an angiotensin receptor blocker with either azelnidipine or a thiazide diuretic produced similar reductions in albuminuria in hypertensive diabetic patients for the same levels of blood pressure achieved.
  
  
  METHODS
  Hypertensive patients with type 2 diabetes and albuminuria (30-600 mg/g creatinine) under antihypertensive treatment (mean age 67.0±7.6 years) were instructed to stop all antihypertensive treatment and take a combination of olmesartan (20 mg/day) and amlodipine (5 mg/day) for 3 months (run-in period). Then, patients were randomly assigned to receive either olmesartan plus azelnidipine (16 mg/day; n=71) or olmesartan plus trichlormethiazide (1 mg/day; n=72) for an additional 6 months. The primary end point was urinary excretion of albumin at 6 months after randomization.
  
  
  RESULTS
  At the time of randomization, urinary albumin was 116.0 and 107.8 mg/g creatinine (geometric mean) in the azelnidipine and diuretic arms, respectively, and was reduced to a similar extent [79.8 (95% confidence interval 66.4-96.0) and 89.7 (74.6-107.7) mg/g creatinine, respectively, after adjustment for baseline values]. Blood pressure did not differ between the two groups throughout the study period.
  
  
  CONCLUSIONS
  Azelnidipine is equally effective as a thiazide diuretic in reducing urinary albumin when used in combination with olmesartan.
authors.affiliation: Department of Internal Medicine, Komono Kosei Hospital, Komono, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Kojima
authors.forename: Setsuya
authors.initials: S
authors.lastname: Okubo
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Mizubayashi
authors.forename: Naoki
authors.initials: N
authors.lastname: Isaka
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Machida
authors.forename: Shinya
authors.initials: S
authors.lastname: Okamoto
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Hirota
authors.forename: Misao
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Takuya
authors.initials: T
authors.lastname: Kato
authors.forename: Kaname
authors.initials: K
authors.lastname: Nakatani
authors.forename: Osamu
authors.initials: O
authors.lastname: Mizuno
authors.forename: Koichi
authors.initials: K
authors.lastname: Miyagawa
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Makino
authors.forename: Takanobu
authors.initials: T
authors.lastname: Okura
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Dohi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ito
authors.forename: Genjiro
authors.initials: G
authors.lastname: Kimura
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001383:Azetidinecarboxylic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D048909:Diabetes Complications / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D004095:Dihydropyridines / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007093:Imidazoles / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013777:Tetrazoles / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004095:Dihydropyridines; D007093:Imidazoles; D013777:Tetrazoles; D001383:Azetidinecarboxylic Acid; C437965:olmesartan; C061679:azelnidipine
keywords: angiotensin receptor blocker; calcium channel blocker; combination therapy; glomerular filtration rate