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(Hypertension. 2009;54:113.)
© 2009 American Heart Association, Inc.

Original Articles

Blood Pressure–Independent Reduction in Proteinuria and Arterial Stiffness After Acute Endothelin-A Receptor Antagonism in Chronic Kidney Disease

Neeraj Dhaun; Iain M. MacIntyre; Vanessa Melville; Pajaree Lilitkarntakul; Neil R. Johnston; Jane Goddard; David J. Webb

From the Clinical Pharmacology Unit (N.D., I.M.M., V.M., P.L., N.R.J., D.J.W.), University of Edinburgh, Queen’s Medical Research Institute; and the Department of Renal Medicine (J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.

Correspondence to Neeraj Dhaun, Queen’s Medical Research Institute, 3rd Floor East, Room E3.23, 47 Little France Crescent, Edinburgh, EH16 4TJ United Kingdom. E-mail bean.dhaun{at}ed.ac.uk

Endothelin 1 is implicated in the development and progression of chronic kidney disease and associated cardiovascular disease. We, therefore, studied the effects of selective endothelin-A receptor antagonism with BQ-123 on key independent surrogate markers of cardiovascular risk (blood pressure, proteinuria and renal hemodynamics, arterial stiffness, and endothelial function) in patients with nondiabetic chronic kidney disease. In a double-blind, randomized crossover study, 22 subjects with proteinuric chronic kidney disease received, on 2 separate occasions, placebo or BQ-123. Ten of these subjects also received nifedipine (10 mg) as an active control for the antihypertensive effect of BQ-123. Blood pressure, pulse wave velocity, flow-mediated dilation, renal blood flow, and glomerular filtration rate were monitored after drug dosing. BQ-123 reduced blood pressure (mean arterial pressure: –7±1%; P<0.001 versus placebo) and increased renal blood flow (17±4%; P<0.01 versus placebo). Glomerular filtration rate remained unchanged. Proteinuria (–26±4%; P<0.01 versus placebo) and pulse wave velocity (–5±1%; P<0.001 versus placebo) fell after BQ-123, but flow-mediated dilation did not change. Nifedipine matched the blood pressure and renal blood flow changes seen with BQ-123. Nevertheless, BQ-123 reduced proteinuria (–38±3% versus 26±11%; P<0.001) and pulse wave velocity (–9±1% versus –3±1%; P<0.001) to a greater extent than nifedipine. Selective endothelin-A receptor antagonism reduced blood pressure, proteinuria, and arterial stiffness on top of standard treatment in renal patients. Furthermore, these studies suggest that the reduction in proteinuria and arterial stiffness is partly independent of blood pressure. If maintained longer term, selective endothelin-A receptor antagonism may confer cardiovascular and renal benefits in patients with chronic kidney disease.

Key Words: endothelin • blood pressure • arterial stiffness • proteinuria • chronic kidney disease

Related Article:

Treatment of Chronic Proteinuric Kidney Disease: What Next?

Ariela Benigni and Giuseppe Remuzzi
Hypertension 2009 54: 29-31. [Extract] [Full Text] [PDF]

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				N. Dhaun, I. M. MacIntyre, V. Melville, P. Lilitkarntakul, N. R. Johnston, J. Goddard, and D. J. Webb Effects of Endothelin Receptor Antagonism Relate to the Degree of Renin-Angiotensin System Blockade in Chronic Proteinuric Kidney Disease Hypertension, September 1, 2009; 54(3): e19 - e20. [Full Text] [PDF]

				A. Benigni and G. Remuzzi Treatment of Chronic Proteinuric Kidney Disease: What Next? Hypertension, July 1, 2009; 54(1): 29 - 31. [Full Text] [PDF]