The short-term effects of angiotensin II receptor blockers on albuminuria and renal function in Korean patients

Abstract

Each angiotensin II receptor blocker (ARB) asserts independent molecular effects. No study has compared the renoprotective potency of different types of ARBs in Korea. This study evaluated the differences among medications for treating albuminuria. Data were obtained from electronic medical records of adult patients who underwent albuminuria test and received treatment with either angiotensin-converting enzyme inhibitors (ACEIs) or ARBs between January 2009 and June 2016. Patients' albuminuria and renal function data were observed for three months after treatment initiation. In total, 1475 patients were included. Patients treated with ACEIs had no significant changes in albuminuria (from 127.7 +/- 55.1 mg/g to 46.7 +/- 18.7 mg/g, P = .127), but those treated with ARBs showed significant improvement (from 491.2 +/- 33.2 mg/g to 372.0 +/- 28.0 mg/g, P < .001). The ARB group had significantly more patients with normal albuminuria after treatment (from 55.8% to 59.3% for normal albuminuria, from 16.7% to 18.5% for moderately increased albuminuria and from 27.5% to 22.2% for severely increased albuminuria, P = .005), but renal function did not change significantly. Subgroup analysis of ARB types showed that candesartan (from 712.5 +/- 71.1 to 489.8 +/- 57.8 mg/g, P < .001) and irbesartan (from 522.6 +/- 65.7 to 352.6 +/- 54.3 mg/g, P < .001) had significant effects. Candesartan improved albuminuria in patients older than 60 years (from 506.9 +/- 84.2 to 371.9 +/- 70.6 mg/g, P = .004) and irbesartan improved albuminuria in patients with glomerular filtration rate <60 (from 551.6 +/- 100.0 to 392.4 +/- 76.2, P = .007). Only irbesartan and candesartan could reduce albuminuria, suggesting that all ARBs do not have the same outcome. This indicates the importance of optimizing ARB selection, considering both patient condition and organ-specific characteristics of medications.