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Abstract

THE EFFECT OF ANGIOTENSIN CONVERTING ENZYME INHIBITORS AND/OR ANGIOTENSIN RECEPTOR BLOCKERS VERSUS CALCIUM CHANNEL BLOCKERS ON PROGRESSION OF CHRONIC KIDNEY DISEASE IN PATIENTS WITH HYPERTENSION IN SUDAN

Israa S. Abdelrahim*, Hasan Abu-Aisha and Abduelmula R. Abduelakrem

ABSTRACT

Background: Chronic kidney disease (CKD) is a worldwide disease with a prevalence rate of 10% to 13%. Hypertension (HTN) is closely associated with CKD and it has the highest prevalence among the major non-communicable diseases in Sudan. The Sudan Guidelines for the Management of HTN in adults recommend that the first line drug of pharmacological intervention is to start with a diuretic or one of the long-acting calcium channel blockers (CCBs). This is based on the notion that African groups have low renin levels and therefore may not respond well to angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). Yet, many physicians in Sudan start their hypertensive patients on ACEIs or ARBs and claim that they get good control of the HTN. One of the important objectives of good control of HTN in CKD patents is to prevent/ slow down progression to end stage renal disease (ESRD). This study aimed to assess the effect of ACEIs and ARBs drugs versus CCBs on hypertensive CKD patients regarding control of blood pressure (BP) and the effect on progression to higher classes of CKD. Methods: This is a prospective cohort study on 240 patients with CKD and HTN who were treated by their respective physicians in three major hospital in Khartoum, Sudan, The patients were divided into two groups according to their medical records: those who were treated with ACEIs or ARBs on the one hand (Group 1) and those treated with CCBs on the other hand (Group 2): The medical records were reviewed by one of researchers and the patients were interviewed. BP measurements and personal and laboratory data were recorded. The same patients were called upon about one year later and reevaluated to assess their BP control and state of CKD progression. Results: Overall the effect of ACEIs/ARBs and CCBs on the degree of control of BP were comparable up to one year of follow up (FU), there being no statistically significant differences between the mean SB P2 and mean DB (P1-P2) of the two groups by the end of the study. The mean serum creatinine, however, was consistently lower in Group 1 compared to Group 2 at the beginning of the study and after one year of FU. However, the estimated glomerular filtration rate (eGFR) was not significantly different between the two groups during the first assessment, but was significantly higher in Group 1 compared to Group 2 by the end of one year FU (P=0.021). The urinary protein excretion (grams / day) was significantly lower in Group 1 by the end of the study. Overall, 28.5% of patients in Group 1, compared to 55.5% of patients in Group 2 progressed to higher classes of CKD (P <0.001). When stratified by the class of CKD, more patients progressed from CKD1 to CKD2 in the CCBs group compared to ACEIs/ARBs group by the end of FU. This effect was also found, though to a lesser degree in higher classes of CKD. Conclusion: The results showed that the BP was fairly well controlled in both groups using either regimen of medications up to one year of FU. However, more patients progressed to higher classes of CKD, and proteinuria was more pronounced in the CCBs group. Serum potassium levels were significantly higher in the ACEIs/ARBs group but the potassium levels were within the acceptable normal range up to the end of the study.

Keywords: ACEI; ARBs; CCB; CKD; Hypertension; Progression of Chronic Kidney Disease.


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