 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15 April 1993 | Volume 118 Issue 8 | Pages 577-581
Objective: To evaluate the long-term effect of angiotensin-converting enzyme inhibition on proteinuria and on the rate of decline in kidney function in patients with type II diabetes mellitus and microalbuminuria.
Design: Randomized, double-blind, placebo-controlled trial. Each patient was followed for 5 years.
Setting: Six clinics for diabetes mellitus coordinated by a department of medicine in a university hospital in Israel.
Patients: Ninety-four normotensive, type II diabetic patients with microalbuminuria and normal renal function.
Intervention: The patients were randomly assigned to receive enalapril, 10 mg per day, or placebo. Any increase in blood pressure was treated with long-acting nifedipine.
Measurements: Albuminuria, blood pressure, serum creatinine, fasting blood glucose, and glycosylated hemoglobin levels, every 3 to 4 months.
Results: In the patients treated with enalapril, albuminuria decreased from 143 ± 64 (mean ±SD) mg/24 h to 122 ± 67 mg/24 h during the first year. Thereafter, we observed a slow increase to 140 ± 134 mg/24 h after 5 years. In the placebo group, albuminuria increased from 123 ± 58 mg/24 h to 310 ± 167 mg/24 h after 5 years. (Difference in rate of change in proteinuria [P < 0.05]). Kidney function (expressed as mean reciprocal creatinine) declined by 13% in the placebo group and remained stable (- 1%) in the enalapril group (P < 0.05). Control of blood glucose levels remained stable, in both groups, throughout the study. The mean blood pressure was stable in the enalapril group (initial group mean, 99 ± 2.1 mm Hg; fifth-year mean, 100 ± 3.2 mm Hg) and increased in the placebo group from an initial mean value of 97 ± 3.2 mm Hg to 102 ± 3.4 mm Hg at the end of the study period (P = 0.082).
Conclusions: In normotensive patients with diabetes mellitus type II, the institution of angiotensin-converting enzyme inhibition during early stages of diabetic nephropathy results in long-term stabilization of plasma creatinine levels and of the degree of urinary loss of albumin. These effects are probably independent of the antihypertensive action of these agents.
Author and Article Information
From the Sackler Faculty of Medicine, Tel Aviv University, Israel; Meir Hospital, Kfar-Saba, Israel.
ARTICLE
Long-Term Stabilizing Effect of Angiotensin-Converting Enzyme Inhibition on Plasma Creatinine and on Proteinuria in Normotensive Type II Diabetic Patients
Requests for Reprints: Mordchai Ravid, MD, Department of Medicine A, Meir Hospital, Kfar-Saba 44281, Israel.
Grant Support: By the Nissenson-Tyomkin medical research grant.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  J. Thompson, M. Reid, I. Hambleton, and G. R. Serjeant Albuminuria and Renal Function in Homozygous Sickle Cell Disease: Observations From a Cohort Study Arch Intern Med, April 9, 2007; 167(7): 701 - 708. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Giunti, D. Barit, and M. E. Cooper Mechanisms of Diabetic Nephropathy: Role of Hypertension Hypertension, October 1, 2006; 48(4): 519 - 526. [Full Text] [PDF]
|
|
|
|
 |
|
 S. L. Johnson, E. F. Tierney, K. U. Onyemere, C.-W. Tseng, M. M. Safford, A. J. Karter, A. Ferrara, O. K. Duru, A. F. Brown, K.M. V. Narayan, et al. Who Is Tested for Diabetic Kidney Disease and Who Initiates Treatment?: The Translating Research Into Action for Diabetes (TRIAD) study Diabetes Care, August 1, 2006; 29(8): 1733 - 1738. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Sugaru, T. Nakagawa, M. Ono-Kishino, J. Nagamine, T. Tokunaga, M. Kitoh, W. E. Hume, R. Nagata, and M. Taiji SMP-534 ameliorates progression of glomerular fibrosis and urinary albumin in diabetic db/db mice Am J Physiol Renal Physiol, April 1, 2006; 290(4): F813 - F820. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. Caramori, P. Fioretto, and M. Mauer Enhancing the Predictive Value of Urinary Albumin for Diabetic Nephropathy J. Am. Soc. Nephrol., February 1, 2006; 17(2): 339 - 352. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Zhou, D. J.M. Isaman, S. Messinger, M. B. Brown, R. Klein, M. Brandle, and W. H. Herman A Computer Simulation Model of Diabetes Progression, Quality of Life, and Cost Diabetes Care, December 1, 2005; 28(12): 2856 - 2863. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Sugaru, M. Sakai, K. Horigome, T. Tokunaga, M. Kitoh, W. E. Hume, R. Nagata, T. Nakagawa, and M. Taiji SMP-534 inhibits TGF-{beta}-induced ECM production in fibroblast cells and reduces mesangial matrix accumulation in experimental glomerulonephritis Am J Physiol Renal Physiol, November 1, 2005; 289(5): F998 - F1004. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Swift, N. D. Markandu, G. A. Sagnella, F. J. He, and G. A. MacGregor Modest Salt Reduction Reduces Blood Pressure and Urine Protein Excretion in Black Hypertensives: A Randomized Control Trial Hypertension, August 1, 2005; 46(2): 308 - 312. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. V Lerma Review: ACE inhibitors, but not angiotensin II receptor antagonists, reduce all cause mortality in diabetic nephropathy Evid. Based Med., June 1, 2005; 10(3): 77 - 77. [Full Text] [PDF]
|
|
|
|
|
|
Y. Nagai, L. Yao, H. Kobori, K. Miyata, Y. Ozawa, A. Miyatake, T. Yukimura, T. Shokoji, S. Kimura, H. Kiyomoto, et al. Temporary Angiotensin II Blockade at the Prediabetic Stage Attenuates the Development of Renal Injury in Type 2 Diabetic Rats J. Am. Soc. Nephrol., March 1, 2005; 16(3): 703 - 711. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Ravera, E. Ratto, S. Vettoretti, D. Parodi, and G. Deferrari Prevention and Treatment of Diabetic Nephropathy: The Program for Irbesartan Mortality and Morbidity Evaluation J. Am. Soc. Nephrol., March 1, 2005; 16(3_suppl_1): S48 - S52. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. E. Lok, M. J. Oliver, D. M. Rothwell, and J. E. Hux The growing volume of diabetes-related dialysis: a population based study Nephrol. Dial. Transplant., December 1, 2004; 19(12): 3098 - 3103. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. H. Barnett, S. C. Bain, P. Bouter, B. Karlberg, S. Madsbad, J. Jervell, J. Mustonen, and the Diabetics Exposed to Telmisartan and Enalapril Angiotensin-Receptor Blockade versus Converting-Enzyme Inhibition in Type 2 Diabetes and Nephropathy N. Engl. J. Med., November 4, 2004; 351(19): 1952 - 1961. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. W. Asselbergs, G. F.H. Diercks, H. L. Hillege, A. J. van Boven, W. M.T. Janssen, A. A. Voors, D. de Zeeuw, P. E. de Jong, D. J. van Veldhuisen, W. H. van Gilst, et al. Effects of Fosinopril and Pravastatin on Cardiovascular Events in Subjects With Microalbuminuria Circulation, November 2, 2004; 110(18): 2809 - 2816. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S M Marshall Recent advances in diabetic nephropathy Postgrad. Med. J., November 1, 2004; 80(949): 624 - 633. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Y. S. Leung, W.-Y. So, P. C. Y. Tong, M. K. W. Lo, K.-F. Lee, G. T. C. Ko, W.-B. Chan, C. S. Cockram, B. M. Brenner, S. Shahinfar, et al. The renoprotective effects of structured care in a clinical trial setting in type 2 diabetic patients with nephropathy Nephrol. Dial. Transplant., October 1, 2004; 19(10): 2519 - 2525. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Deferrari, M. Ravera, V. Berruti, G. Leoncini, and L. Deferrari Optimizing Therapy in the Diabetic Patient with Renal Disease: Antihypertensive Treatment J. Am. Soc. Nephrol., January 1, 2004; 15(90010): S6 - 11. [Abstract] [Full Text]
|
|
|
|
|
|
M. K. Haroun, B. G. Jaar, S. C. Hoffman, G. W. Comstock, M. J. Klag, and J. Coresh Risk Factors for Chronic Kidney Disease: A Prospective Study of 23,534 Men and Women in Washington County, Maryland J. Am. Soc. Nephrol., November 1, 2003; 14(11): 2934 - 2941. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Perez de Lema, C. de Wit, C. D. Cohen, E. Nieto, A. Molina, B. Banas, B. Luckow, A. B. Vicente, F. Mampaso, and D. Schlondorff Angiotensin Inhibition Reduces Glomerular Damage and Renal Chemokine Expression in MRL/lpr Mice J. Pharmacol. Exp. Ther., October 1, 2003; 307(1): 275 - 281. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Svensson, G. Sundkvist, H. J. Arnqvist, E. Bjork, G. Blohme, J. Bolinder, M. Henricsson, L. Nystrom, O. Torffvit, I. Waernbaum, et al. Signs of Nephropathy May Occur Early in Young Adults With Diabetes Despite Modern Diabetes Management: Results from the nationwide population-based Diabetes Incidence Study in Sweden (DISS) Diabetes Care, October 1, 2003; 26(10): 2903 - 2909. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. A.M. Zandbergen, M. G.A. Baggen, S. W.J. Lamberts, A. H. Bootsma, D. de Zeeuw, and R. J.Th. Ouwendijk Effect of Losartan on Microalbuminuria in Normotensive Patients with Type 2 Diabetes Mellitus: A Randomized Clinical Trial Ann Intern Med, July 15, 2003; 139(2): 90 - 96. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Benigni, C. Zoja, D. Corna, C. Zatelli, S. Conti, M. Campana, E. Gagliardini, D. Rottoli, C. Zanchi, M. Abbate, et al. Add-On Anti-TGF-{beta} Antibody to ACE Inhibitor Arrests Progressive Diabetic Nephropathy in the Rat J. Am. Soc. Nephrol., July 1, 2003; 14(7): 1816 - 1824. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. J. Kramer, Q. D. Nguyen, G. Curhan, and C.-y. Hsu Renal Insufficiency in the Absence of Albuminuria and Retinopathy Among Adults With Type 2 Diabetes Mellitus JAMA, June 25, 2003; 289(24): 3273 - 3277. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Stigant, L. Stevens, and A. Levin Nephrology: 4. Strategies for the care of adults with chronic kidney disease Can. Med. Assoc. J., June 10, 2003; 168(12): 1553 - 1560. [Full Text] [PDF]
|
|
|
|
|
|
M. B. Davidson The Case for "Outsourcing" Diabetes Care Diabetes Care, May 1, 2003; 26(5): 1608 - 1612. [Full Text] [PDF]
|
|
|
|
|
|
S. Vijan and R. A. Hayward Treatment of Hypertension in Type 2 Diabetes Mellitus: Blood Pressure Goals, Choice of Agents, and Setting Priorities in Diabetes Care Ann Intern Med, April 1, 2003; 138(7): 593 - 602. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Gaede, H. P. Hansen, H.-H. Parving, and O. Pedersen Impact of low-dose acetylsalicylic acid on kidney function in type 2 diabetic patients with elevated urinary albumin excretion rate Nephrol. Dial. Transplant., March 1, 2003; 18(3): 539 - 542. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. D. Mooradian Cardiovascular Disease in Type 2 Diabetes Mellitus: Current Management Guidelines Arch Intern Med, January 13, 2003; 163(1): 33 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. C. Sasso, O. Carbonara, M. Persico, D. Iafusco, T. Salvatore, R. D'Ambrosio, R. Torella, and D. Cozzolino Irbesartan Reduces the Albumin Excretion Rate in Microalbuminuric Type 2 Diabetic Patients Independently of Hypertension: A randomized double-blind placebo-controlled crossover study Diabetes Care, November 1, 2002; 25(11): 1909 - 1913. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Deferrari, M. Ravera, L. Deferrari, S. Vettoretti, E. Ratto, and D. Parodi Renal and Cardiovascular Protection in Type 2 Diabetes Mellitus: Angiotensin II Receptor Blockers J. Am. Soc. Nephrol., November 1, 2002; 13(90003): S224 - 229. [Abstract] [Full Text]
|
|
|
|
|
|
S. W. Tobe, P. A. McFarlane, and D. M. Naimark Microalbuminuria in diabetes mellitus Can. Med. Assoc. J., September 1, 2002; 167(5): 499 - 503. [Full Text]
|
|
|
|
|
|
Z. T. Bloomgarden Treatment of Type 2 Diabetes: The American Association of Clinical Endocrinologists Meeting, May 2002 Diabetes Care, September 1, 2002; 25(9): 1644 - 1649. [Full Text] [PDF]
|
|
|
|
|
|
G. Viberti, N. M. Wheeldon, and for the MicroAlbuminuria Reduction With VALsartan Microalbuminuria Reduction With Valsartan in Patients With Type 2 Diabetes Mellitus: A Blood Pressure-Independent Effect Circulation, August 6, 2002; 106(6): 672 - 678. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. P Garg and G. L Bakris Microalbuminuria: marker of vascular dysfunction, risk factor for cardiovascular disease Vascular Medicine, February 1, 2002; 7(1): 35 - 43. [Abstract] [PDF]
|
|
|
|
 |
|
 M. A J Devonald and F. E Karet Targeting the renin-angiotensin system in patients with renal disease J R Soc Med, January 8, 2002; 95(8): 391 - 397. [Full Text] [PDF]
|
|
|
|
|
|
A. M.E. Spoelstra-de Man, C. B. Brouwer, C. D.A. Stehouwer, and Y. M. Smulders Rapid Progression of Albumin Excretion Is an Independent Predictor of Cardiovascular Mortality in Patients With Type 2 Diabetes and Microalbuminuria Diabetes Care, December 1, 2001; 24(12): 2097 - 2101. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. Lewis, L. G. Hunsicker, W. R. Clarke, T. Berl, M. A. Pohl, J. B. Lewis, E. Ritz, R. C. Atkins, R. Rohde, I. Raz, et al. Renoprotective Effect of the Angiotensin-Receptor Antagonist Irbesartan in Patients with Nephropathy Due to Type 2 Diabetes N. Engl. J. Med., September 20, 2001; 345(12): 851 - 860. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. M. Brenner, M. E. Cooper, D. de Zeeuw, W. F. Keane, W. E. Mitch, H.-H. Parving, G. Remuzzi, S. M. Snapinn, Z. Zhang, S. Shahinfar, et al. Effects of Losartan on Renal and Cardiovascular Outcomes in Patients with Type 2 Diabetes and Nephropathy N. Engl. J. Med., September 20, 2001; 345(12): 861 - 869. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-H. Parving, H. Lehnert, J. Brochner-Mortensen, R. Gomis, S. Andersen, P. Arner, and the Irbesartan in Patients with Type 2 Diabetes an The Effect of Irbesartan on the Development of Diabetic Nephropathy in Patients with Type 2 Diabetes N. Engl. J. Med., September 20, 2001; 345(12): 870 - 878. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Huston and R. Peterson Withholding Proven Treatment in Clinical Research N. Engl. J. Med., September 20, 2001; 345(12): 912 - 914. [Full Text] [PDF]
|
|
|
|
|
|
M. P. Cohen, C. W. Shearman, and G. T. Lautenslager Serum Type IV Collagen in Diabetic Patients at Risk for Nephropathy Diabetes Care, August 1, 2001; 24(8): 1324 - 1327. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. P. Cohen, G. T. Lautenslager, and C. W. Shearman Increased Collagen IV Excretion in Diabetes: A marker of compromised filtration function Diabetes Care, May 1, 2001; 24(5): 914 - 918. [Abstract] [Full Text]
|
|
|
|
|
|
W. THOMAS, Y. SHEN, M. E. MOLITCH, and M. W. STEFFES Rise in Albuminuria and Blood Pressure in Patients Who Progressed to Diabetic Nephropathy in the Diabetes Control and Complications Trial J. Am. Soc. Nephrol., February 1, 2001; 12(2): 333 - 340. [Abstract] [Full Text]
|
|
|
|
|
|
M. W. Taal, G. M. Chertow, H. G. Rennke, A. Gurnani, T. Jiang, A. Shahsafaei, J. L. Troy, B. M. Brenner, and H. S. Mackenzie Mechanisms underlying renoprotection during renin-angiotensin system blockade Am J Physiol Renal Physiol, February 1, 2001; 280(2): F343 - F355. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. J. Cheng, T. Vaskonen, I. Tikkanen, K. Nurminen, H. Ruskoaho, H. Vapaatalo, D. Muller, J.-K. Park, F. C. Luft, and E. M. A. Mervaala Endothelial Dysfunction and Salt-Sensitive Hypertension in Spontaneously Diabetic Goto-Kakizaki Rats Hypertension, February 1, 2001; 37(2): 433 - 439. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A.O. Phillips Diabetic nephropathy--where next? QJM, October 1, 2000; 93(10): 643 - 646. [Full Text] [PDF]
|
|
|
|
|
|
E. Grossman, F. H. Messerli, and J. M. Neutel Angiotensin II Receptor Blockers: Equal or Preferred Substitutes for ACE Inhibitors? Arch Intern Med, July 10, 2000; 160(13): 1905 - 1911. [Full Text] [PDF]
|
|
|
|
 |
|
 M. B. Davidson, V. J. Karlan, and T. L. Hair Effect of a Pharmacist-Managed Diabetes Care Program in a Free Medical Clinic American Journal of Medical Quality, July 1, 2000; 15(4): 137 - 142. [Abstract] [PDF]
|
|
|
|
|
|
R. H. Mehta, T. J. Ruane, P. A. McCargar, K. A. Eagle, and E. J. Stalhandske The Treatment of Elderly Diabetic Patients With Acute Myocardial Infarction: Insight From Michigan's Cooperative Cardiovascular Project Arch Intern Med, May 8, 2000; 160(9): 1301 - 1306. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Petrie, A. D. Morris, S. Ueda, M. Small, R. Donnelly, J. M. C. Connell, and H. L. Elliott Trandolapril Does Not Improve Insulin Sensitivity in Patients with Hypertension and Type 2 Diabetes: A Double-Blind, Placebo-Controlled Crossover Trial J. Clin. Endocrinol. Metab., May 1, 2000; 85(5): 1882 - 1889. [Abstract] [Full Text]
|
|
|
|
|
|
R. A. Rodby, R. D. Rohde, W. R. Clarke, L. G. Hunsicker, D. A. Anzalone, R. C. Atkins, E. Ritz, and E. J. Lewis The Irbesartan Type II Diabetic Nephropathy Trial: study design and baseline patient characteristics Nephrol. Dial. Transplant., April 1, 2000; 15(4): 487 - 497. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. SOMA, T. SAITO, Y. TAGUMA, S. CHIBA, H. SATO, K. SUGIMURA, S. OGAWA, and S. ITO High Prevalence and Adverse Effect of Hepatitis C Virus Infection in Type II Diabetic-Related Nephropathy J. Am. Soc. Nephrol., April 1, 2000; 11(4): 690 - 699. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. F. Clark, D. N. Churchill, L. Forwell, G. Macdonald, and S. Foster To pay or not to pay? A decision and cost-utility analysis of angiotensin-converting-enzyme inhibitor therapy for diabetic nephropathy Can. Med. Assoc. J., January 1, 2000; 162(2): 195 - 198. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. D. Feldman, N. Campbell, P. Larochelle, P. Bolli, E. D. Burgess, S. G. Carruthers, J. S. Floras, R. B. Haynes, G. Honos, F. H.H. Leenen, et al. 1999 Canadian recommendations for the management of hypertension Can. Med. Assoc. J., December 14, 1999; 161(90120): S1 - 17. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Golan, J. D. Birkmeyer, and H. G. Welch The Cost-Effectiveness of Treating All Patients with Type 2 Diabetes with Angiotensin-Converting Enzyme Inhibitors Ann Intern Med, November 2, 1999; 131(9): 660 - 667. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Ritz and S. R. Orth Nephropathy in Patients with Type 2 Diabetes Mellitus N. Engl. J. Med., October 7, 1999; 341(15): 1127 - 1133. [Full Text] [PDF]
|
|
|
|
|
|
S. M. Grundy, I. J. Benjamin, G. L. Burke, A. Chait, R. H. Eckel, B. V. Howard, W. Mitch, S. C. Smith Jr, and J. R. Sowers Diabetes and Cardiovascular Disease : A Statement for Healthcare Professionals From the American Heart Association Circulation, September 7, 1999; 100(10): 1134 - 1146. [Full Text] [PDF]
|
|
|
|
 |
|
 S. P. Marso, S. G. Ellis, E. M. Tuzcu, P. L. Whitlow, I. Franco, R. E. Raymond, and E. J. Topol The importance of proteinuria as a determinant of mortality following percutaneous coronary revascularization in diabetics J. Am. Coll. Cardiol., April 1, 1999; 33(5): 1269 - 1277. [Abstract] [Full Text] [PDF]
|
|
|
|
< |
Article
