Anti-proteinuric Effect of Ramipril and Cilnidipine in Diabetic Nephropathy - A Comparative Study

Open Access

Abstract

Background: Reduction of proteinuria leads to reduced risk of adverse renal and cardiovascular events. Angiotensin-converting enzyme (ACE) inhibitors have been established to be first-line drugs in preventing the development and retarding the progress of diabetic nephropathy by reducing proteinuria. Apart from this Cilnidipine a dihydropyridine derivative dual L/N type calcium channel blocker also has effect on reducing proteinuria by mechanism that differs from that of ACEI. Objective: To compare the anti-proteinuric effect of Cilnidipine and Ramipril. Methods & Materials: This randomized control experimental study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka for the duration of 10 months. Diabetic Nephropathy Patients were taken as the study population. Total 93 subjects were enrolled as study sample with a view to determine the presence of proteinuria in Diabetic Nephropathy patients. Informed written consent was taken from all study population. Data were obtained in preformed data collection sheet and analyzed by SPSS program version 26. Results: Mean age of the study population was in Group A was 45.9±13.5 years and 50.1±12.1 in Group B. Male female distribution in two groups were matched. At enrolment the mean systolic blood pressure recorded of the patients was 132.6±6.1 mmHg and the mean diastolic blood pressure 82.8±6.8 mmHg, after addition of Ramipril and Cilnidipine there was a reduction of blood pressure at 3 and 6 months. The mean UTP level in Group A at the start of study was 4.87±1.85 gm and in Group B 5.35±1.78 gm. At the end of 3 months, the mean UTP was 4.47±1.65 in Group A and 4.70±1.66 in Group B. The mean UTP reduction from baseline at the end of 6 months in Group A was 2.88±1.25 while in Group B it was 3.78±1.48 (p < 0.001). The mean uACR level in Group A at the start of study was 2223.4±163.8 gm and in Group B 2821.9±159.4 gm. At the end of 3 months, the mean uACR was 1964.6±142.6 mg/gm in Group A and 2415.6±144.0 mg/gm in Group B. The mean uACR reduction from baseline at the end of 6 months in Group A was 1190.5±98.7 mg/gm while in Group B it was 1828.9±116.9 mg/gm (p=0.004). Conclusion: We conclude that in diabetic population, Ramipril has better effect on proteinuria reduction than Cilnidipine.