Efficacy of drugs in controlling microalbuminuria of diabetic nephropathy
Keywords:Microalbuminuria, Diabetic nephropathy, Angiotensin converting enzyme inhibitor, Angiotensin II receptor blocker
Background: Beneficial effect in reducing microalbuminuria of diabetic nephropathy with angiotensin converting enzyme (ACE) inhibitor and angiotensin II receptor blockers (ARB) is proven. This study has directly compared the renoprotective effects of ARB and ACE inhibitors in persons with type-2 diabetes.
Methods: In this prospective, double-blind, controlled trial, 100 patients with type 2 diabetes mellitus were chosen and randomly assigned to either receive ACE inhibitor (ramipril 5 mg, 50 patients) or ARB (losartan 50 mg, 50 patients). The endpoint was a reduction in 24 hrs urine microalbuminuria after a period of 3 months treatment. Results: At the end of 3 months treatment, the mean reduction of 24 hrs urine microalbuminuria in the ramipril group was 25 mg as compared to 38 mg in the losartan group; (t value=1.11, p=0.27). There was no statistical difference in the mean reduction when compared between the two groups. Significant reduction of blood pressure especially systolic blood pressure was noted in the losartan group as compared to those who received ramipril.
Conclusion: Losartan was not inferior to ramipril in providing renoprotection in subjects with type 2 diabetes and early nephropathy. Losartan showed a significant reduction in systolic blood pressure, though not much reduction was seen with ramipril. Despite this, both drugs have shown a reduction in microalbuminuria, which supports the fact that reduction in microalbuminuria is independent of the antihypertensive action of ramipril or losartan.
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047-53. [DOI via Crossref]
Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345:861-9. [DOI via Crossref]
Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB, et al. Renoprotective effect of the angiotensin receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345:851-60. [DOI via Crossref]
Parving HH, Lehnert H, Brochner-Mortensen J, Gomis R, Andersen S, Arner P, et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med. 2001;345:870-8. [DOI via Crossref]
Heart Outcomes Prevention Evaluation Study Investigators: Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet. 2000;355:253-9. [DOI via Crossref]
Lindholm LH, Ibsen H, Dahlof B, Devereux RB, Beevers G, de Faire U, Fyhrquist F, et al. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan intervention for endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002;359:1004-10. [DOI via Crossref]
Thurman JM, Schrier RW. Comparative effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on blood pressure and the kidney. Am J Med. 2003;114:588-98. [DOI via Crossref]
Barnett AH, Bain SC, Bouter P, Karlberg B, Madsbad S. Angiotensin-receptor blockade versus converting â€“ Enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med. 2004;351:1952-61. [DOI via Crossref]
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. [DOI via Crossref]
American diabetes association: nephropathy in diabetes (Position Statement). Diabetes Care. 2004;27 Suppl 1:S79-83. [DOI via Crossref]
Kvetny J, Gregersen G, Pedersen RS. Randomized placebo-controlled trial of perindopril in normotensive, normoalbuminuric patients with type 1 diabetes mellitus. Q J Med. 2001;94:89-94. [DOI via Crossref]
Weinberg MS, Kaperonis N, Bakris GL. How high should an ACE inhibitor or angiotensin receptor blocker be dosed in patients with diabetic nephropathy? Curr Hypertens Rep. 2003;5(5):418-25. [DOI via Crossref]