Improve Your Self

Unwind the Relationship

Role High Blood Pressure Medicine in Chronic Kidney Disease

This is post analyses research articles written about Role High Blood Pressure Medicine in Chronic Kidney Disease. Many of us are taking various blood pressure medications because our nephrologist referred to us. What exactly these medicines do in patients with co-morbid microalbuminuria, renal dysfunction  and do they help in controlling chronic kidney disease. Let us see what research have been done in this.

Types of High Blood Pressure Medicine in Chronic Kidney Disease

When it comes to kidney disease, two types of blood pressure-lowering medications, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are preffered. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance that narrows your blood vessels. Angiotensin II receptor blockers (ARBs) block the action of angiotensin II from binding to angiotensin II receptors on the muscles surrounding blood vessels. Hence the blood vessels enlarge (dilate) and blood pressure is reduced.

Role High Blood Pressure Medicine in Chronic Kidney Disease

ARBs such as candesartan, losartan, olmesartan and valsartan are the most effective anti-hypertensive agents for the prevention of ESRD and in diabetic patients with nephropathy, they suppresses both oxidative stress and inflammation. Losartan reduced the risk of ESRD by 28% and decrease proteinuria by 35% with patients with diabteic nephropathy. Irbesartan reduced serum creatinine level by 33% and ESRD by 23%.

ACEs such as ramipril, benazepril, captopril and lisinopril are used to treat renal pressure. A research compared different ACE Inhibitors in Patients With Chronic Heart Failure and they mentioned Eneapril increased ejection fraction, stroke volume, and decreased mean arterial pressure. However, enalapril was associated with the highest incidence of cough, gastrointestinal discomfort, and greater deterioration in renal function. Lisinopril the worst choice among the ACE inhibitors, Ramipril was associated with the lowest incidence of all-cause mortality and Trandolapril ranked first in reducing systolic and diastolic blood pressure. 

The dose of the bp medicine is decided by the doctor depending on the stages of kidney disease. and the amount of bp the patient currently has. The aim is to reduce bp to 120/80 mm Hg (120 over 80). There are 5 stages for CKD.

Stages of Kidney Disease

Stage Description Glomerular Filtration Rate (GFR)*
Stage 1 - Kidney damage (e.g., protein in the urine) with normal GFR 90 or above
Stage 2 -  Kidney damage with mild decrease in GFR 60 to 89
Stage 3 - Moderate decrease in GFR 30 to 59
Stage 4 - Severe reduction in GFR 15 to 29
Stage 5 - Kidney failure Less than 15

Enalapril versus losartan in CKD

A research compared Enalapril and Losatrtan and mentioned Enalapril carries a higher risk of dry cough than Losartan. In a study, 70 patients with a median glomerular filtration rate (GFR) of 15 (range, 6 to 54) mL/min/1.73 m2 were followed with 2 years and found that the progress to CKD was lower in enalapril group. In another article, ACE inhibitors may have a possible occurrence of hyperkalaemia and the patients might consider checking serum pottacium level.

New research shows that ACEi/ARB cessation theoretically restores the capacity for auto-regulation within the kidney, allowing RAAS activation and results in a rise in the GFR but other study recommends use of Antihypertensive Therapy in the Presence of Proteinuria.  A study on the Effects of telmisartan and enalapril on renoprotection in patients with mild to moderate chronic kidney disease shows that telmisartan results in a greater reduction of urinary markers than does enalapril.

1. Effect of Captopril ACEs on Diabetic Nephropathy - 207 patinets received captopril and 202 received placibo. Captopril treatment was associated with a 50 percent reduction in the risk of the combined end points of death, dialysis, and transplantation that was independent of the small disparity in blood pressure between the groups.

2. Effect of Benazepril on CKD-  Three-year trial involving 583 patients were conducted. 300 patients received benazepril and 283 received placebo. The sudy concluded that Benazepril provides protection against the progression of renal insufficiency in patients with various renal diseases except patients with polycystic disease.

3. Effect of ACEs in Nephrotic Proteinuria - 46 nondiabetic patients with nephrotic proteinuria treated with captopril for a minimum of 12 months. Study concluded that a significant antiproteinuric effect of captopril in patients with nephrotic proteinuria is accompanied by an arrest in the progression of renal insufficiency; in addition, an amelioration of lipid profile was observed during the treatment.

4. Effect of Enalapril on Proteinuria Long Term - 30 day course of enalapril on glomerular barrier function in 10 patients with IgA nephropathy and proteinuria. Though immediate proteinuria was successfully treated, proteinuria came back to the basal value when enalapril was stopped. This shows the possible undesired effect of ACEs in long-term treatment. 

Another study compared Manidipine and enalapril and patients treated with enalapril showed a better antiproteinuric response. A study in children mentioned that Enalapril is effective in reducing proteinuria in children with CKD and might be renal protective in proteinuric CKD. Another study in children mentioned in children with proteinuria, losartan and enalapril significantly reduced proteinuria. Enalapril further ameliorates proteinuria if administered along with renal diet in dogs.

New study titled "Treatment of IgA Nephropathy with ACE Inhibitors: A Randomized and Controlled Trial" states that forty-four patients with biopsy-proven IgAN, proteinuria ≥ 0.5 g/d, and serum creatinine (SCr) ≤ 1.5 mg/dl were taken for the research. Out of that 23 people were randomly assigned to receive enalapril (n = 23) 21 were given other antihypertensives other than ACE inhibitors. In Enalapril group, protenurai was significantly lower. 3 patients in enalapril group and 12 in the control group had a 50% increase in baseline serum creatinine level. 

As far as the studies are concerned, use of BP medicines in reducing proteinuria is well established.  Along with that patient must understand the loss of kidney’s ability to remove salt in CKD. Therefore dietary salt restriction and appropriate diuretic therapy is needed to manage the situation. Bedtime dosing of anti hypertensive medications can restore nocturnal dips in BP. Patients also should check of stomach discomfort, potassium level while on blood pressure medications.

You can read more on Effect of Probiotics and Diet on Reversing Chronic Kidney Disease.