HALT
HALT trial
5 year blood pressure study of PKDDrugs Telmisartan Lisinopril
Tight blood pressure control is thought to delay dialysis and/or transplant by at least 15 years. The HALT study looked at which blood pressure medications might be best for PKD.
HALT trial results
The Halt study results confirm that keeping lower blood pressures (perhaps to the point of dizziness) might be best for PKD kidney health. This is a blood pressure that is at or below 120/80. ACE and Receptor site blockers all are antagonists for renin-angiotensin-aldosterone system (RAAS); they decrease proteinuria, they increase perfusion (blood supply) to the kidneys, and lower blood pressure."In a study of 558 patients with ADPKD, rigorous blood pressure control conferred benefits over standard blood pressure control related to a reduced rate of increase in total kidney volume and greater declines in measures of heart and kidney problems. "Hypertension was very well controlled in both treatment groups. The results emphasize the potential importance of early detection and aggressive treatment of hypertension in ADPKD," said lead author Arlene Chapman, M.D."
Stage 3 CKD
"Also in a study of 486 ADPKD patients with stage 3 chronic kidney disease, treatment with an angiotensin-converting
enzyme inhibitor (ACE-1) was safe and by itself sufficient to achieve blood pressure control in the majority of patients.
"Both studies showed that ACE inhibitors alone or in combination with angiotensin receptor blockers are safe and well tolerated
and achieve excellent blood pressure control in the majority of patients with ADPKD," said lead author Vicente Torres, M.D., Ph.D. "However, both failed to demonstrate any superiority of dual blockage with an ACE inhibitor and an angiotensin receptor blocker
compared to an ACE inhibitor alone."
"These two studies provide important guidance for the care of patients with ADPKD. They show that blood pressure
can be controlled with ACE inhibitors, drugs that have an acceptable safety profile. They suggest that rigorous
blood-pressure control, early in the disease process, may slow cyst growth and reduce the left-ventricular-mass index,
but this approach is complicated by increased dizziness."
Data from the HALT PKD study shows that pain is a common early symptom in the course of ADPKD. Also from the HALT study the incidence of left ventricular hypertrophy (LVH) appears to be decreasing among PKD'rs.
"RAAS inhibitors has been shown to induce regression of LVH, and this may continue to play an important role in the cardiovascular risk management in patients with ADPKD."
Japanese study
Japan is studying PKD blood pressure similar to the design of the HALT study.Lanreotide Trial to decrease PKD
In the Netherlands they are looking at lanreotide as a medication to halt ADPKD progression.The Mario Negri Institute in Italy had a small study showing that octreotide (used ↓ PLD liver cysts) analogues were useful for slowing progression of ADPKD.
Caution with the frail and elderly
ACEi and ARB should be used with caution in the elderly. There was an association of increased hospital admissions from these individuals using both ACE and Angiotensin Receptor Site Blockers.