Source: DGNews  |  Posted 8 years ago

By Paula Moyer

BERLIN, GERMANY -- June 12, 2003 -- Adding the calcium channel blockers verapamil or amlodipine does not appear to significantly increase the antiproteinuric effect of totrandolapril in patients with nondiabetic nephropathy.

"Neither verapamil nor amlodipine increased the antiproteinuric effect in patients treated with the [angiotensin-converting enzyme] ACE inhibitor trandolapril," reported Robert Boero, MD, a staff nephrologist at the S.G. Bosco Hospital, in Turin, Italy.

In addition, Dr. Boero and colleagues found that the combination of trandolapril and verapamil was better tolerated than trandolapril and amlodipine. He presented the findings here June 9th at the World Congress of Nephrology.

The investigators conducted their study to see whether the combination of the non-dihydropyridine calcium channel blocker verapamil or the dihydropyridine calcium channel blocker amlodipine, when combined with trandolapril, reduced proteinuria more than trandolapril alone in patients with nondiabetic proteinuric nephropathies. They also intended to evaluate the effects of these treatments on the selectivity of proteinuria, such as clearance of immunoglobulin G (IgG) or albumin, and the drugs' safety in these patients.

The team recruited 49 men and 20 women with nondiabetic nephropathies and an average of 54 years of age. Mean baseline serum creatinine level was 1.9 mg/dL, and mean baseline blood pressure was 136/90 mm Hg.

Patients went through a 1-month washout period from any ACE inhibitor or any angiotensin receptor blocker. Then they all received 2 mg daily of trandolapril in an open-label fashion for 1 month, after which they were randomly assigned to receive either 180 mg of verapamil or 5 mg of amlodipine daily for 8 months, in a double-blind phase. There were 33 patients in the verapamil arm and 36 in the amlodipine arm.

After 1 month on trandolapril monotherapy, the mean 24-hour proteinuria level was significantly reduced, from 3,078 mg to 2,537