Source: DGNews  |  Posted 6 years ago

By Maria Bishop

PHILADELPHIA, PA -- November 16, 2005 -- Once-daily maximum dosing of trandolapril achieves an optimal antiproteinuric effect in non-diabetics with renal disease, researchers reported here at the 38[^]th[] Annual Meeting and Scientific Exposition of the American Society of Nephrology (ASN).

Elsi A. van der Wouden, MS, Pharmacist, Department of Clinical Pharmacy, University Medical Center, Groningen, Leeuwarden, The Netherlands, presented the findings on November 12[^]th[].

Ms van der Wouden and colleagues conducted the study to determine whether alternative dosing of the long-acting angiotensin-converting enzyme (ACE) inhibitor trandolapril could overcome relative nocturnal therapy resistance and further reduce proteinuria in non-diabetics with renal disease.

The team observed seven men and seven women with renal disease who were non-diabetic. Patients had residual proteinuria of more than 1 g that did not respond to renin-angiotensin-aldosterone system (RAAS) inhibitor treatment.

In the study, patients received a 4-mg morning dose of trandolapril for 6 weeks. Other RAAS-inhibitors were stopped, while non-RAAS inhibiting antihypertensive medication was continued.

After 6 weeks, the subjects were randomised to a 4-mg evening dose or 2 mg twice daily in a cross-over fashion (6 weeks each). To control for time influences, the morning dose was repeated at the end of the study.

At the end of each 6-week period, urine samples were collected from all patients in daytime and nighttime portions, twice in 24 hours. The researchers also measured proteinuria and blood pressure.

Residual proteinuria as well as blood pressure were found to be equal during all therapy regimen periods. No change in the day/night proteinuria rhythm was observed. Sodium and protein intakes were not significantly different among the different dosing-regimens.

Ms. van der Wouden noted that trandolapril, as a long-acting ACE inhibitor, did not increase the nocturnal antiproteinuric response in study subjects, she acknowledged that a shorter-acting ACE inhibitor might also be effective.

As nighttime protein excretion contributes to residual proteinuria, it is an important target for therapy, she said.

[Presentation title: Altered Dosing of Trandolapril Does Not Overcome Nocturnal Resistance to the Antiproteinuric Effect of ACE Inhibition in Non-Diabetic Renal Disease. Abstract 1036]