• Mohd Makmor-Bakry Faculty of Pharmacy, Universiti kebangsaan Malaysia
  • Normi Hamdan Hospital Seri Manjung Malaysia


Proteinuria, Protein creatinine index, ACEI, ARB


Objective: This study investigated the effect of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin-ii receptor blockers (ARBs) on protein creatinine index (PCI) of patients with hypertension in a standard care practice.

Methods: This retrospective study was carried out in a tertiary hospital. Hypertensive patients were randomly selected and screened based on inclusion and exclusion criteria. PCI values were obtained from the patient’s medical record.

Results: No significant differences were observed in the percentage of patients with proteinuria (PCI ≥20 mg/mmol creatinine) at pre-and post-treatment among the patients treated with ACEI, ARB or non-ACEI/ARB. Patients treated with ACEI (-10 mg/mmol creatinine; IQR-37.5-+10; p<0.046) and ARB (-10 mg/mmol creatinine; IQR-30-+10; p<0.048) showed significant reduction in PCI values at post-treatment compared to the non-ACEI/ARB group (+5 mg/mmol creatinine; IQR 0-+32.5).

Conclusion: Our findings demonstrated that standard care practice, the therapy of ACEI and ARB did not sufficiently reduce the number of patients with proteinuria but could reduce progression of the proteinuria.


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Wittmann I, Molnár GA, Degrell P, Wagner Z, Tamaskó M, Laczy B, et al. Prevention and treatment of diabetic nephropathy. Diabetes Res Clin Prac 2005;68:S36-42.

National Kidney Foundation. K/DOQI Clinical practice guideline for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 2002;39:S1-299.

Keane WF, Eknoyan G. Proteinuria, albuminuria, risk, assessment, detection, elimination (PARADE): a position paper of the national kidney foundation. Am J Kidney Dis 1999;33:1004-10.

Jones CA, Francis ME, Eberhardt MS, Chavers B, Coresh J, Engelgau M, et al. Microalbumnuria in the US population: third national health and nutrition examination survey. Am J Kidney Dis 2002;39:445-59.

Berrut G, Bouhanick B, Fabbri P, Guilloteau G, Bled F, Le Jeune JJ, et al. Microalbuminuria as a predictor of a drop in glomerular filtration rate in subjects with non-insulin-dependent diabetes mellitus and hypertension. Clin Nephrol 1997;48:92-7.

Valmadrid CT, Klein R, Moss SE, Klein BE. The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus. Arch Intern Med 2000;160:1093-100.

Anavekar NS, Gans DJ, Berl T, Rohde RD, Cooper W, Bhaumik A, et al. Predictors of cardiovascular events in patients with type 2 diabetic nephropathy and hypertension: a case for albuminuria. Kidney Int Suppl 2004;92:S50-5.

Jager A, van Hinsbergh VW, Kostense PJ, Emeis JJ, Nijpels G, Dekker JM, et al. C-reactive protein and soluble vascular cell adhesion molecule-1 are associated with elevated urinary albumin excretion but do not explain its link with cardiovascular risk. Arterioscler Thromb Vasc Biol 2002;22:593-8.

Melbourne Diabetic Nephropathy Study Group. Comparison between perindopril and nifedipine in hypertensive and normotensive diabetic patients with microalbuminuria. Br Med J 1991;302:210-6.

Esnault VL, Brown EA, Apetrei E, Bagon J, Calvo C, DeChatel R, et al. The effects of amlodipine and enalapril on renal function in adults with hypertension and nondiabetic nephropathies: A 3-year, randomized, multicenter, double-blind, placebo-controlled study. Clin Ther 2008;30:482-98.

Parving HH, Lehnert H, Bröchner-Mortensen J, Gomis R, Andersen S, Arner P. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Eng J Med 2001;345:870-8.

Viberti G, Wheeldon NM. Microalbuminuria reduction with valsartan in patients with type 2 diabetes mellitus: a blood pressure-independent effect. Circulation 2002;106:672-8.

de Zeeuw D, Remuzzi G, Parving HH, Keane WF, Zhang Z, Shahinfar S, et al. Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation 2004;110:921-7.

Ibsen H, Olsen MH, Wachtell K, Borch-Johnsen K, Lindholm LH, Mogensen CE, et al. Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients: losartan intervention for endpoint reduction in hypertensive study. Hypertension 2005;45:198-202.

Remuzzi G, Bertani T. Pathophysiology of progressive nephropathies. N Eng J Med 1998;339:1448-56.

Abbate M, Benigni A, Bertani T, Remuzzi G. Nephrotoxicity of increased glomerular protein traffic. Nephrol Dial Transplant 1999;14:304-12.

Ruggenenti P, Perna A, Gherardi G, Garini G, Zoccali C, Salvadori M, et al. Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet 1999;354:359-64.

Eijkelkamp WB, Zhang Z, Remuzzi G, Parving HH, Cooper ME, Keane WF, et al. Albuminuria is a target for renoprotective therapy independent from blood pressure in patients with type 2 diabetic nephropathy: Post hoc analysis from the reduction of end points in NIDDM with angiotensin II antagonist Losartan (RENAAL) trial. J Am Soc Nephrol 2007;18:1540-6.



How to Cite

Makmor-Bakry, M., and N. Hamdan. “EFFECT OF ANGIOTENSIN CONVERTING ENZYME INHIBITORS AND ANGIOTENSIN-II RECEPTOR BLOCKERS ON PROTEINURIA OF HYPERTENSIVE PATIENTS IN STANDARD CARE PRACTICE”. International Journal of Pharmacy and Pharmaceutical Sciences, vol. 7, no. 11, Nov. 2015, pp. 40-43, https://innovareacademics.in/journals/index.php/ijpps/article/view/7110.



Original Article(s)