Therapeutic Research

Abstract

Aims：This study was undertaken to evaluate the pleiotropic, urinary albumin excretion（UAE）–decreasing effect of combined therapy with olmesartan and azelnidipine（ OL＋AZ）. Methods：The subjects were 46 outpatients aged 75 years or less, who had abnormal glucose metabolism and hypertension. In the intervention group, OL＋AZ doses were titrated to achieve a goal blood pressure of ＜130/80 mmHg. Therapy was instituted at 10mg ＋ 8 mg, and if necessary titrated, and blood pressure and UAE were determined after 3.5 and 7 months of therapy. A control group of 92 subjects, matched with the intervention group in age, sex, blood pressure, and HbA1c （NGSP）, did not have their doses of ACE–I or ARB changed. Results：In the intervention group, blood pressure significantly improved（ p＜0.0001）at 3.5 months of therapy. A logistic regression analysis revealed that a high UAE at baseline was a predictor （correlation coefficient, 0.255; standard error, 0.121; p ＝ 0.034） for a subsequent decrease in UAE. An ROC analysis showed that the cut point appropriate for predicting a decrease in UAE （sensitivity, 0.905; specificity, 0.857; AUC, 0.895） was a baseline UAE level of 10 mg/g Cr. Furthermore, when the patients with UAE levels 10 mg/g Cr were compared to patients with UAE levels ＜10 mg/g Cr, there was no significant difference between the two groups in blood pressure at baseline and in blood pressure decrease due to OL＋AZ therapy. Nevertheless, in 27 patients with baseline UAE levels 10mg/g Cr, the relative change in UAE was - 30±51％ and - 36±28％ after 3.5 and 7 months, respectively and they are significantly decreased compared to 17 patients with UAE levels ＜10 mg/g Cr （p＜0.005, p＜0.0001, respectively）. In the control group, a blood pressure–dependent UAE–decreasing effect was observed. Conclusions：OL＋AZ therapy had a blood pressure –independent, pleiotropic,UAE–decreasing effect in patients with baseline UAE levels 10 mg/g Cr.