Interim evidence of the renoprotective effect of the angiotensin II receptor antagonist losartan versus the calcium channel blocker amlodipine in patients with chronic kidney disease and hypertension

A report of the Japanese Losartan Therapy Intended for Global Renal Protection in Hypertensive Patients (JLIGHT) Study

Yasuhiko Iino, Matsuhiko Hayashi, Tetsuya Kawamura, Tatsuo Shiigai, Yasuhiko Tomino, Kenichi Yamada, Takeyuki Kitajima, Terukuni Ideura, Akio Koyama, Tetsuzo Sugisaki, Hiromichi Suzuki, Satoshi Umemura, Yoshindo Kawaguchi, Shunya Uchida, Michio Kuwahara, Tsutomu Yamazaki

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background. Insufficiency of renal function and high blood pressure influence each other and eventually result in life-threatening endstage renal disease. It has been proposed that proteinuria per se is a determinant of the progression of chronic kidney disease (CKD). The therapeutic strategy for -patients with proteinuric CKD and hypertension should therefore be targeted with a view not merely toward blood pressure reduction but also toward renoprotection. Methods. We examined the effect of the angiotensin (AT) 1 receptor antagonist losartan and the calcium channel blocker amlodipine, throughout a period of 12 months, on reduction of blood pressure and renoprotection. This was done by assessing amounts of urinary protein excretion, serum creatinine (SCr), and creatinine clearance (CCr) in patients with hypertension (systolic blood pressure [SBP] ≧ 140 mmHg or diastolic blood pressure [DBP] ≧ 90 mmHg) and CKD (male, body weight [BW] ≧ 60kg: 1.5 ≦ SCr < 3.0 mg/dl; female or male BW < 60kg: 1.3 ≦ SCr < 3.0 mg/dl), manifesting proteinuria of 0.5 g or more/day. Losartan was administered once daily at doses of 25 to 100 mg/day, and amlodipine was given once daily at 2.5 to 5 mg/day. No antihypertensive combination therapy was allowed during the first 3-month period. Results. A 3-month interim analysis revealed that, despite there being no difference in blood pressure between the two groups, there was a significant reduction in 24-h urinary protein excretion in the losartan group (n = 43), but there was no change in the amlodipine group (n = 43). Analysis of stratified subgroups with proteinuria of 2 g or more/day and less than 2 g/day showed that losartan lowered proteinuria by approximately 24% in both subgroups, while amlodipine lowered proteinuria by 10%, but only in the subgroup of less than 2 g/day (NS). SCr and CCr did not change throughout the period of 3 months in either group. No severe or fatal adverse event was experienced in either group during the study period. Conclusions. Losartan appeared to be efficacious for renoprotection in patients with proteinuric CKD and hypertension, with the mechanism being independent of its antihypertensive action.

Original languageEnglish
Pages (from-to)221-230
Number of pages10
JournalClinical and Experimental Nephrology
Volume7
Issue number3
DOIs
Publication statusPublished - 2003 Sep

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Amlodipine
Losartan
Angiotensin Receptor Antagonists
Calcium Channel Blockers
Chronic Renal Insufficiency
Creatinine
Proteinuria
Blood Pressure
Hypertension
Kidney
Antihypertensive Agents
Therapeutics
Serum
Body Weight
Renal Insufficiency
Blood Proteins

Keywords

  • Amlodipine
  • Angiotensin
  • Creatinine
  • Hypertension
  • Kidney
  • Losartan
  • Proteinuria

ASJC Scopus subject areas

  • Nephrology

Cite this

Interim evidence of the renoprotective effect of the angiotensin II receptor antagonist losartan versus the calcium channel blocker amlodipine in patients with chronic kidney disease and hypertension : A report of the Japanese Losartan Therapy Intended for Global Renal Protection in Hypertensive Patients (JLIGHT) Study. / Iino, Yasuhiko; Hayashi, Matsuhiko; Kawamura, Tetsuya; Shiigai, Tatsuo; Tomino, Yasuhiko; Yamada, Kenichi; Kitajima, Takeyuki; Ideura, Terukuni; Koyama, Akio; Sugisaki, Tetsuzo; Suzuki, Hiromichi; Umemura, Satoshi; Kawaguchi, Yoshindo; Uchida, Shunya; Kuwahara, Michio; Yamazaki, Tsutomu.

In: Clinical and Experimental Nephrology, Vol. 7, No. 3, 09.2003, p. 221-230.

Research output: Contribution to journalArticle

Iino, Yasuhiko ; Hayashi, Matsuhiko ; Kawamura, Tetsuya ; Shiigai, Tatsuo ; Tomino, Yasuhiko ; Yamada, Kenichi ; Kitajima, Takeyuki ; Ideura, Terukuni ; Koyama, Akio ; Sugisaki, Tetsuzo ; Suzuki, Hiromichi ; Umemura, Satoshi ; Kawaguchi, Yoshindo ; Uchida, Shunya ; Kuwahara, Michio ; Yamazaki, Tsutomu. / Interim evidence of the renoprotective effect of the angiotensin II receptor antagonist losartan versus the calcium channel blocker amlodipine in patients with chronic kidney disease and hypertension : A report of the Japanese Losartan Therapy Intended for Global Renal Protection in Hypertensive Patients (JLIGHT) Study. In: Clinical and Experimental Nephrology. 2003 ; Vol. 7, No. 3. pp. 221-230.
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abstract = "Background. Insufficiency of renal function and high blood pressure influence each other and eventually result in life-threatening endstage renal disease. It has been proposed that proteinuria per se is a determinant of the progression of chronic kidney disease (CKD). The therapeutic strategy for -patients with proteinuric CKD and hypertension should therefore be targeted with a view not merely toward blood pressure reduction but also toward renoprotection. Methods. We examined the effect of the angiotensin (AT) 1 receptor antagonist losartan and the calcium channel blocker amlodipine, throughout a period of 12 months, on reduction of blood pressure and renoprotection. This was done by assessing amounts of urinary protein excretion, serum creatinine (SCr), and creatinine clearance (CCr) in patients with hypertension (systolic blood pressure [SBP] ≧ 140 mmHg or diastolic blood pressure [DBP] ≧ 90 mmHg) and CKD (male, body weight [BW] ≧ 60kg: 1.5 ≦ SCr < 3.0 mg/dl; female or male BW < 60kg: 1.3 ≦ SCr < 3.0 mg/dl), manifesting proteinuria of 0.5 g or more/day. Losartan was administered once daily at doses of 25 to 100 mg/day, and amlodipine was given once daily at 2.5 to 5 mg/day. No antihypertensive combination therapy was allowed during the first 3-month period. Results. A 3-month interim analysis revealed that, despite there being no difference in blood pressure between the two groups, there was a significant reduction in 24-h urinary protein excretion in the losartan group (n = 43), but there was no change in the amlodipine group (n = 43). Analysis of stratified subgroups with proteinuria of 2 g or more/day and less than 2 g/day showed that losartan lowered proteinuria by approximately 24{\%} in both subgroups, while amlodipine lowered proteinuria by 10{\%}, but only in the subgroup of less than 2 g/day (NS). SCr and CCr did not change throughout the period of 3 months in either group. No severe or fatal adverse event was experienced in either group during the study period. Conclusions. Losartan appeared to be efficacious for renoprotection in patients with proteinuric CKD and hypertension, with the mechanism being independent of its antihypertensive action.",
keywords = "Amlodipine, Angiotensin, Creatinine, Hypertension, Kidney, Losartan, Proteinuria",
author = "Yasuhiko Iino and Matsuhiko Hayashi and Tetsuya Kawamura and Tatsuo Shiigai and Yasuhiko Tomino and Kenichi Yamada and Takeyuki Kitajima and Terukuni Ideura and Akio Koyama and Tetsuzo Sugisaki and Hiromichi Suzuki and Satoshi Umemura and Yoshindo Kawaguchi and Shunya Uchida and Michio Kuwahara and Tsutomu Yamazaki",
year = "2003",
month = "9",
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TY - JOUR

T1 - Interim evidence of the renoprotective effect of the angiotensin II receptor antagonist losartan versus the calcium channel blocker amlodipine in patients with chronic kidney disease and hypertension

T2 - A report of the Japanese Losartan Therapy Intended for Global Renal Protection in Hypertensive Patients (JLIGHT) Study

AU - Iino, Yasuhiko

AU - Hayashi, Matsuhiko

AU - Kawamura, Tetsuya

AU - Shiigai, Tatsuo

AU - Tomino, Yasuhiko

AU - Yamada, Kenichi

AU - Kitajima, Takeyuki

AU - Ideura, Terukuni

AU - Koyama, Akio

AU - Sugisaki, Tetsuzo

AU - Suzuki, Hiromichi

AU - Umemura, Satoshi

AU - Kawaguchi, Yoshindo

AU - Uchida, Shunya

AU - Kuwahara, Michio

AU - Yamazaki, Tsutomu

PY - 2003/9

Y1 - 2003/9

N2 - Background. Insufficiency of renal function and high blood pressure influence each other and eventually result in life-threatening endstage renal disease. It has been proposed that proteinuria per se is a determinant of the progression of chronic kidney disease (CKD). The therapeutic strategy for -patients with proteinuric CKD and hypertension should therefore be targeted with a view not merely toward blood pressure reduction but also toward renoprotection. Methods. We examined the effect of the angiotensin (AT) 1 receptor antagonist losartan and the calcium channel blocker amlodipine, throughout a period of 12 months, on reduction of blood pressure and renoprotection. This was done by assessing amounts of urinary protein excretion, serum creatinine (SCr), and creatinine clearance (CCr) in patients with hypertension (systolic blood pressure [SBP] ≧ 140 mmHg or diastolic blood pressure [DBP] ≧ 90 mmHg) and CKD (male, body weight [BW] ≧ 60kg: 1.5 ≦ SCr < 3.0 mg/dl; female or male BW < 60kg: 1.3 ≦ SCr < 3.0 mg/dl), manifesting proteinuria of 0.5 g or more/day. Losartan was administered once daily at doses of 25 to 100 mg/day, and amlodipine was given once daily at 2.5 to 5 mg/day. No antihypertensive combination therapy was allowed during the first 3-month period. Results. A 3-month interim analysis revealed that, despite there being no difference in blood pressure between the two groups, there was a significant reduction in 24-h urinary protein excretion in the losartan group (n = 43), but there was no change in the amlodipine group (n = 43). Analysis of stratified subgroups with proteinuria of 2 g or more/day and less than 2 g/day showed that losartan lowered proteinuria by approximately 24% in both subgroups, while amlodipine lowered proteinuria by 10%, but only in the subgroup of less than 2 g/day (NS). SCr and CCr did not change throughout the period of 3 months in either group. No severe or fatal adverse event was experienced in either group during the study period. Conclusions. Losartan appeared to be efficacious for renoprotection in patients with proteinuric CKD and hypertension, with the mechanism being independent of its antihypertensive action.

AB - Background. Insufficiency of renal function and high blood pressure influence each other and eventually result in life-threatening endstage renal disease. It has been proposed that proteinuria per se is a determinant of the progression of chronic kidney disease (CKD). The therapeutic strategy for -patients with proteinuric CKD and hypertension should therefore be targeted with a view not merely toward blood pressure reduction but also toward renoprotection. Methods. We examined the effect of the angiotensin (AT) 1 receptor antagonist losartan and the calcium channel blocker amlodipine, throughout a period of 12 months, on reduction of blood pressure and renoprotection. This was done by assessing amounts of urinary protein excretion, serum creatinine (SCr), and creatinine clearance (CCr) in patients with hypertension (systolic blood pressure [SBP] ≧ 140 mmHg or diastolic blood pressure [DBP] ≧ 90 mmHg) and CKD (male, body weight [BW] ≧ 60kg: 1.5 ≦ SCr < 3.0 mg/dl; female or male BW < 60kg: 1.3 ≦ SCr < 3.0 mg/dl), manifesting proteinuria of 0.5 g or more/day. Losartan was administered once daily at doses of 25 to 100 mg/day, and amlodipine was given once daily at 2.5 to 5 mg/day. No antihypertensive combination therapy was allowed during the first 3-month period. Results. A 3-month interim analysis revealed that, despite there being no difference in blood pressure between the two groups, there was a significant reduction in 24-h urinary protein excretion in the losartan group (n = 43), but there was no change in the amlodipine group (n = 43). Analysis of stratified subgroups with proteinuria of 2 g or more/day and less than 2 g/day showed that losartan lowered proteinuria by approximately 24% in both subgroups, while amlodipine lowered proteinuria by 10%, but only in the subgroup of less than 2 g/day (NS). SCr and CCr did not change throughout the period of 3 months in either group. No severe or fatal adverse event was experienced in either group during the study period. Conclusions. Losartan appeared to be efficacious for renoprotection in patients with proteinuric CKD and hypertension, with the mechanism being independent of its antihypertensive action.

KW - Amlodipine

KW - Angiotensin

KW - Creatinine

KW - Hypertension

KW - Kidney

KW - Losartan

KW - Proteinuria

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U2 - 10.1007/s10157-003-0241-3

DO - 10.1007/s10157-003-0241-3

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