[Variations in microalbuminuria in essential hypertension treated with ACE inhibitors, calcium antagonists and their association]. / Variazione della microalbuminuria in ipertesi essenziali trattati con ACE-inibitori, calcioantagonisti e loro associazione.

OBJECTIVE: Microalbuminuria is an early and sensible marker of renal impairment; furthermore, many authors consider it an independent predictive index for cardiovascular morbidity and mortality. In our study we observed this parameter in hypertensive patients treated respectively with ACE-inhibitors, calcium channel blockers and their combination. EXPERIMENTAL DESIGN: Open comparative trial, 6 months follow-up. ENVIRONMENT: Outpatients, with no changes from usual lifestyle; office measurements. PATIENTS: Forty patients (22 men and 18 women) aged 52-78 years, with essential hypertension and microalbuminuria; diabetics and subjects with renal impairment were excluded. TREATMENT: Chronic antihypertensive drug therapy, respectively with nitrendipine 20 mg/die (Group A, n = 10), lisinopril 20 mg/die (Group B, n = 20), and lisinopril 20 mg/die+nitrendipine 20 mg/die (Group C, n = 10); all drugs were administered orally. MEASUREMENTS: Detection of urinary albumin excretion with immunochemical method (Micral Test); urine samples were taken immediately after arousal for three consecutive days; office blood pressure monitoring (sitting and standing) during the same day, with at least 2 separate readings. RESULTS: Out of 34 patients examined at follow-up, (8 from Group A, 17 from Group B and 9 from Group C) urinary albumin excretion rates were as follows: Group A: reduction (but not disappearance) in 3 patients (37%), no change in 4 patients (50%), increase in 1 patient (13%); Group B: disappearance in 11 patients (65%), reduction in 3 patients (17.5%), no changes in 3 patients (17.5%); Group C: reduction (but not disappearance) in 5 patients (55.5%), no changes in 4 patients (44.5%). CONCLUSIONS: In hypertensive patients not diabetics and not renally impaired with microalbuminuria, ACE-inhibitors appear to be a move suitable drug therapy than calcium channel blockers or the combination ACE-inhibitor+calcium channel blocker.