title: (99m)Tc-DTPA scintigraphy assesses the absence of glomerular filtration rate impairment of Aliskiren in high-risk hypertensive subjects. A 12-month follow-up study.
abstract: OBJECTIVE
  Glomerular filtration rate (GFR) is commonly calculated using the modification of diet in renal disease (MDRD) and Cockroft-Gault (CG) formulas and recently by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) algorithm and not directly measured, so that the real impact of antihypertensive therapy on GFR could not be well defined. In this study, the effect of Aliskiren on the GFR measured by radionuclide clearance of 99mTc-diethylene triamine penta-acetic acid (DTPA) was investigated.
  
  
  METHODS
  In 106 hypertensive subjects (53% men) aged 61.9±12.7 years with uncontrolled blood pressure (BP) receiving at least 2 antihypertensive medications, Aliskiren was added once-daily at a dose of 150-300 mg for 12 months. Clinic BP measurements were taken at every follow-up visit (1st, 6th and 12th month), while 24-hours ambulatory BP and GFR (in mL/min/1.73 m2) were evaluated at baseline and at the end of the follow-up. Analysis of variance for repeated measures of BP, GFR and microalbuminuria was provided.
  
  
  RESULTS
  With the use of Aliskiren a significant reduction of BP and microalbuminuria was found (P<0.0001). Only in male population, a significant reduction in GFR calculated with CKD-EPI (82.4±15 vs. 78.6±18.2, P<0.01) and CG (81.6±29.5 vs. 74.2±28.4, P<0.0001) formulas was observed. This impairment of GFR was not found either with MDRD formula (70.5±19.6 vs. 68.3±23.4) or by radionuclide clearance (62.4±18.6 vs. 61.4±20.5).
  
  
  CONCLUSIONS
  This study seems to demonstrate that the efficacy on BP control of Aliskiren is not accompanied by an impairment of GFR. In order to evaluate the effect of Aliskiren on GFR scintigraphy technique or MDRD formula resulted to be the most accurate methods.
authors.affiliation: Department of Internal Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy - mazza.alberto@azisanrovigo.it.
authors.forename: A
authors.initials: A
authors.lastname: Mazza
authors.forename: D
authors.initials: D
authors.lastname: Montemurro
authors.forename: A M
authors.initials: AM
authors.lastname: Maffione
authors.forename: G
authors.initials: G
authors.lastname: Vescovo
authors.forename: L
authors.initials: L
authors.lastname: Rampin
authors.forename: M
authors.initials: M
authors.lastname: Zuin
authors.forename: L
authors.initials: L
authors.lastname: Schiavon
authors.forename: A
authors.initials: A
authors.lastname: Camerotto
authors.forename: M C
authors.initials: MC
authors.lastname: Marzola
authors.forename: F
authors.initials: F
authors.lastname: Fiorini
authors.forename: D
authors.initials: D
authors.lastname: Rubello
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D005650:Fumarates / Q000009:adverse effects / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D012737:Sex Factors; D016284:Technetium Tc 99m Pentetate; D013997:Time Factors
chemical_list: D000577:Amides; D000959:Antihypertensive Agents; D005650:Fumarates; D019275:Radiopharmaceuticals; C446481:aliskiren; D016284:Technetium Tc 99m Pentetate