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Title: Comparison of renin-angiotensin to calcium channel blockade in renal disease.
Austin Authors: Tikkanen, Ilkka;Johnston, Colin I
Affiliation: Department of Medicine, University of Melbourne, Austin & Repatriation Medical Centre, Australia
Issue Date: 1-Dec-1997
Publication information: Kidney International. Supplement; 63(): S19-22
Abstract: Whether any class of antihypertensive drugs has specific renoprotective effects above and beyond lowering of blood pressure is still debatable. The renin-angiotensin system (RAS) is both localized and has many actions within the kidney, on intrarenal hemodynamics, on the mesangial cell, as well as stimulating growth factors and cytokines. Angiotensin converting enzyme (ACE) inhibitors have been shown to ameliorate the progression of renal failure. How much of this beneficial effect is due to their hemodynamic effects, how much to non-hemodynamic effects and how much to their effects on bradykinin and other putative ACE substrates is still unclear. Experimentally it can be shown that inhibiting ACE but preventing the fall in systemic blood pressure by salt loading abolishes renoprotection. Bradykinin has been implicated in both the beneficial and the adverse effects of ACE inhibitors. Because of this and because ACE inhibitors may not provide complete blockade of the RAS, angiotensin receptor (AT1R) antagonists have been developed. Experimentally AT1R antagonists have been shown to reproduce most of the beneficial effects of ACE inhibitors. The experience in humans is more limited but they have been demonstrated to be efficacious in hypertension, to reduce proteinuria, and produce a favorable hemodynamic effect in congestive cardiac failure with a low incidence of adverse effects and without cough. Calcium channel blockers (CCB) also have additional properties that may provide renoprotection beyond lowering blood pressure. However, as the different types of CCB block different calcium channels their effects may differ substantially. The inconsistency of the data in the renoprotective effect of CCB may reflect these differences. Quantitatively probably the most important factor in preventing the progress of renal failure by antihypertensive drugs is strict control of blood pressure. Lowering blood pressure by drugs is most likely effective by both reducing physical and sheer stress damage, as well as turning off the signal for the activation and production of vasoactive peptides and cytokines.
Gov't Doc #: 9407414
Type: Journal Article
Subjects: Angiotensin II.antagonists & inhibitors
Angiotensin-Converting Enzyme Inhibitors.therapeutic use
Calcium Channel Blockers.therapeutic use
Hypertension, Renovascular.drug therapy.physiopathology
Kidney Diseases.drug therapy.physiopathology
Renin-Angiotensin System.drug effects.physiology
Appears in Collections:Journal articles

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