DOES SELECTION OF ANTIHYPERTENSIVE AGENTS MATTER?
What is currently uncertain is whether ACEI or AT-1-RB should be titrated according to blood pressure or whether, despite no further lowering of blood pressure, the dose should be increased to optimize the decrease in proteinuria. According to recent concepts, proteinuria is a “nephrotoxin”46 and exposure of tubular epithelial cells to protein induces an activated inflammatory phenotype47. In line with the idea that a further increase in the dose of ACEI or AT-1-RB is sensible was provided by the experimental study of Peters et al48. It is plausible that the same principle applies to humans according to some preliminary experience49,50,51. In patients with IgA glomerulonephritis, Palla et al51 showed that increasing doses of lisinopril (5, 10, 15, 20 mg/day) caused progressive decrease in proteinuria (39, 44, 61, and 67%, respectively), although blood pressure was lowered maximally (mean 22%) by the lowest dose of lisinopril.Recently, a role of sympathetic nervous system in progression
