ECE2017 Eposter Presentations: Interdisciplinary Endocrinology Cardiovascular Endocrinology and Lipid Metabolism (9 abstracts)
Renal function preservation with Manidipine vs Amlodipine in type 2 diabetic hypertensive patients with persistent microalbuminuria
Sara Quintana-Arroyo 1 , Claudia Arnas-Leon 1 , Ana Delia Santana-Suarez 1 , Manuel Nivelo-Rivadeneira 1 , Agnieszka Kuzior 1 , Carmen Acosta-Calero 1 , Margarita Saiz-Satjes 3 & Francisco Javier Martinez-Martin 2
1Endocrinology Department, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain; 2Outpatient Hypertension Clinic, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain; 3CAP Rambla HUMT, Terrassa, Barcelona, Spain.
Objectives: The AMANDHA randomized study (PROBE design) showed that the addition of Manidipine 20 mg vs Amlodipine 10 mg for 2 years in 91 hypertensive type 2 diabetic patients with persistent microalbuminuria, uncontrolled with a renin-angiotensin system inhibitor (given full-dose for at least the 6 previous months) was more effective in reducing albuminuria in spite of similar blood pressure control. Patients with significant renal impairment (PlCr >1.4 mg/dl in women and >1.5 in men) had been excluded. However, no data were published on the progression of renal dysfunction, with only PlCr values reported, which were not significantly different. We undertook to establish if there were differences in glomerular filtration rate (GFR) progression.
Methods: Post-hoc analysis of AMANDHA. GFR was estimated by the MDRD-4 equation for each individual measurement. Point-to-point GFR were compared by unpaired t-test and progression was compared by the Kruskal-Wallis test. (non-parametric ANOVA). Values are given as mean (±S.E.M).
Results: Baseline GFR were 67.3 (±5.2) and 70.2 (±5.0) ml/min/1.73 m2 with Manidipine and Amlodipine, respectively; at 6 months they were 68.6 (±5.6) and 69.5 (±5.3), and at two years 66.9 (±4.7) and 65.5 (±5.0). During follow-up, patients treated with Manidipine lost 0.4 (±3.9) ml/min per 1.73 m2 of FGR vs 4.7 (±5.2) with Amlodipine. Point-to-point GFR were not significantly different between the groups, but GFR loss after two years was lower with Manidipine (P=0.032).
Conclusions: The previously published data of AMANDHA showed a markedly greater albuminuria reduction (about 40% more) with Manidipine vs Amlodipine, which was attributed to efferential arteriole dilatation. The present post-hoc analysis also shows a better preservation of renal function with Manidipine. These results strengthens the case for combined treatment with Manidipine and a renin-angiotensin system blocker in hypertensive type 2 diabetic patients with persistent microalbuminuria.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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