Contrasting Effects of Calcium Channel Blockade versus Converting ...

Contrasting

Effects

of Calcium

Converting

Enzyme

Inhibition

Americans

with

Channel

Blockade

on Proteinuria

Non-Insulin-Dependent

versus

in African

Diabetes

Mellitus

and Nephropathy ANTONIO

GUASCH,

CHIKE

NZERUE,

Renal

Abstract.

Hypertension

dependent Americans sion,

of

Division,

MARK

PARHAM,

EDWIN

MACON

and

Department

is a common

of Medicine,

finding

in

are

relatively

converting

calcium

resistant

enzyme

channel

sented

here,

cium

antagonist,

inhibitors

blockers the

to the

(CEI)

but

In the

long-term

(CCB).

effects

of

isradipine,

on the course

patients

were

they

were

topril

(N

levels

(
25 mb/mm; retinopathy;

negative

hepatitis

At the time

preclude

the

to any

i.e.,

and HIV

After

timed blood

urine drawn

was

calculated activity

use

Amerif they

of the

study or if

month

because

patients

of noncompliance,

developed

acute

of obstructive

renal

uropathy

were and

failure

one

with

at 4 months

dropped patient

in

ultrasonoand

was

ex-

eluded from the analysis. Thus, 3 1 African Americans ( 14 men, 17 women) with a median age of 56 years (range. 27-70 yr) were studied; 16 patients were receiving insulin, 10 were treated with an ADA diet alone, and five with diet plus oral hypoglycemic agents. The majority of patients (29 of 3 1) were hypertensive average of two different antihypertensives diuretics in 22 patients, subsequently randomized

were

on CCB;

eight

were

ments. baseline maintained also

and

and were (range,

randomized

were

on CCB

The batter two classes

were

discontinued

required

hydrabazine

with an including

to the captopril

seven

measurements. at < 160/90

treated 1-4),

CCB in 19, and CEI in 15. Of the 16 patients to isradipine. seven were on CEI, and 12

in the 15 patients

on CEI,

In the

interim

with diuretics for

an Isodata

pressure

blood

before

period,

standing

position

blood

pressure

was

sounds,

and

the diastolic

diastolic

for

Based

on published

proteinuria

measured

by

intake

was

IL).

(Palatine,

at each

urinary

(normal

calculated

from

systolic

I Korotkoff of phase

between

chemical

analysis

the coefficient

of variation

(27,28).

6.5%-8.0%).

24-h

urea

were Protein

to avoid inaccurate from one urine cob-

is