 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15 June 1998 | Volume 128 Issue 12 Part 1 | Pages 982-988
Background: Angiotensin-converting enzyme (ACE) inhibitors attenuate the decline in renal function in diabetic patients with microalbuminuria. However, no data are available on the use of ACE inhibitors to prevent the decrease in renal function in normotensive, normoalbuminuric patients with type 2 diabetes.
Objective: To evaluate the effect of prolonged ACE inhibition on renal function and albuminuria in patients with type 2 diabetes.
Design: Randomized, double-blind, placebo-controlled trial with 6-year follow-up.
Setting: Eight outpatient clinics coordinated by a department of medicine in a university hospital.
Patients: 156 patients in whom type 2 diabetes was diagnosed after 40 years of age who had a baseline mean blood pressure less than 107 mm Hg and albuminuria (albumin excretion
Intervention: Enalapril, 10 mg/d, or placebo.
Measurements: Degree of albuminuria at 24 hours, creatinine clearance, blood pressure, and hemoglobin A1C values.
Results: Enalapril therapy decreased albumin excretion from a mean ±SD of 11.6 ± 7 mg/24 h to 9.7 ± 6 mg/24 h at 2 years. This was followed by a gradual increase to 15.8 ± 8 mg/24 h at 6 years. In the placebo group, albumin excretion increased from 10.8 ± 8 mg/24 h to 26.5 ± 10 mg/24 h at 6 years (P = 0.001 for enalapril compared with placebo). Transition to microalbuminuria occurred in 15 of 79 (19%) placebo recipients and 5 of 77 (6.5%) enalapril recipients. Enalapril treatment resulted in an absolute risk reduction of 12.5% (95% CI, 2% to 23%; P = 0.042) for development of microalbuminuria. After 6 years, creatinine clearance decreased from 1.78 ± 0.13 mL/s to 1.63 ± 0.12 mL/s (mean decrease, 0.025 mL/s per year) in enalapril recipients and from 1.81 ± 0.15 mL/s to 1.57 ± 0.17 mL/s (mean decrease, 0.04 mL/s per year) in placebo recipients (P = 0.040). Hemoglobin A1C values decreased modestly in both groups. Mean blood pressure remained normal (<107 mm Hg) in all patients.
Conclusions: Enalapril attenuated the decline in renal function and reduced the extent of albuminuria in normotensive, normoalbuminuric patients with type 2 diabetes. Further research is needed to determine whether this treatment forestalls the development of overt nephropathy.
Author and Article Information
From Tel-Aviv University and Meir Hospital, Kfar-Sava, Israel.
ARTICLE
Use of Enalapril To Attenuate Decline in Renal Function in Normotensive, Normoalbuminuric Patients with Type 2 Diabetes Mellitus
A Randomized, Controlled Trial
30 mg/24 h).
Acknowledgment: The authors thank Professor Lily Neuman from the Department of Epidemiology and Biostatistics, Faculty of Medicine, Ben-Gurion University Beer-Sheva, for guidance in statistical analysis.
Grant Support: In part by a 1994 Yehudith and Avi Tyomkin research grant.
Requests for Reprints: Mordchai Ravid, MD, Meir Hospital, Kfar-Sava 44281, Israel; e-mail: mravid@netvision.net.il.
Current Author Addresses: Dr. M. Ravid: Meir Hospital, Kfar-Sava 44281, Israel.
This article has been cited by other articles:
|
|
 |
|
  H. M Campbell, K. D Boardman, M. A Dodd, and D. W Raisch Pharmacoeconomic Analysis of Angiotensin-Converting Enzyme Inhibitors in Type 2 Diabetes: A Markov Model Ann. Pharmacother., July 1, 2007; 41(7): 1101 - 1110. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Shankar, R. Klein, B. E.K. Klein, F. J. Nieto, and S. E. Moss Relationship Between Low-Normal Blood Pressure and Kidney Disease in Type 1 Diabetes Hypertension, January 1, 2007; 49(1): 48 - 54. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Vora and C. Weston BENEDICT: primary prevention of microalbuminuria in hypertensive type 2 diabetes: Bergamo NEphrologic Diabetes Complication Trial (BENEDICT) The British Journal of Diabetes & Vascular Disease, March 1, 2006; 6(2): 84 - 88. [PDF]
|
|
|
|
 |
|
 G. Montalescot and J.-P. Collet Preserving cardiac function in the hypertensive patient: why renal parameters hold the key Eur. Heart J., December 2, 2005; 26(24): 2616 - 2622. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. F.M. Strippoli, M. Craig, F. P. Schena, and J. C. Craig Antihypertensive Agents for Primary Prevention of Diabetic Nephropathy J. Am. Soc. Nephrol., October 1, 2005; 16(10): 3081 - 3091. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. B. Rosen, M. B. Hamel, M. C. Weinstein, D. M. Cutler, A. M. Fendrick, and S. Vijan Cost-Effectiveness of Full Medicare Coverage of Angiotensin-Converting Enzyme Inhibitors for Beneficiaries with Diabetes Ann Intern Med, July 19, 2005; 143(2): 89 - 99. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. P. Kopyt Slowing Progression Along the Renal Disease Continuum J Am Osteopath Assoc, April 1, 2005; 105(4): 207 - 215. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. T. Bloomgarden Diabetic Nephropathy Diabetes Care, March 1, 2005; 28(3): 745 - 751. [Full Text] [PDF]
|
|
|
|
|
|
Y. Wang, M. C.Y. Ng, W. Y. So, P. C.Y. Tong, R. C.W. Ma, C. C. Chow, C. S. Cockram, and J. C.N. Chan Prognostic Effect of Insertion/Deletion Polymorphism of the ACE Gene on Renal and Cardiovascular Clinical Outcomes in Chinese Patients With Type 2 Diabetes Diabetes Care, February 1, 2005; 28(2): 348 - 354. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Gross, M. J. de Azevedo, S. P. Silveiro, L. H. Canani, M. L. Caramori, and T. Zelmanovitz Diabetic Nephropathy: Diagnosis, Prevention, and Treatment Diabetes Care, January 1, 2005; 28(1): 164 - 176. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. S. Harris, I. Treskov, M. W. Rowley, S. Heximer, K. Kaltenbronn, B. N. Finck, R. W. Gross, D. P. Kelly, K. J. Blumer, and A. J. Muslin G-Protein Signaling Participates in the Development of Diabetic Cardiomyopathy Diabetes, December 1, 2004; 53(12): 3082 - 3090. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Ruggenenti, A. Fassi, A. P. Ilieva, S. Bruno, I. P. Iliev, V. Brusegan, N. Rubis, G. Gherardi, F. Arnoldi, M. Ganeva, et al. Preventing Microalbuminuria in Type 2 Diabetes N. Engl. J. Med., November 4, 2004; 351(19): 1941 - 1951. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Gupta, Y. Birnbaum, and B. F. Uretsky The renal patient with coronary artery disease: Current concepts and dilemmas J. Am. Coll. Cardiol., October 6, 2004; 44(7): 1343 - 1353. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Y. So, R. Ozaki, N. N. Chan, P. C.Y. Tong, C. S. Ho, C. W.K. Lam, G. T.C. Ko, C. C. Chow, W. B. Chan, R. C.W. Ma, et al. Effect of Angiotensin-Converting Enzyme Inhibition on Survival in 3773 Chinese Type 2 Diabetic Patients Hypertension, September 1, 2004; 44(3): 294 - 299. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. M. Field, J. L. Pepin, and M. D. Mehta Knowing When to Play the Ace: The Use and Under Use of Ace Inhibitors in Primary Practice Journal of Pharmacy Practice, June 1, 2004; 17(3): 197 - 210. [Abstract] [PDF]
|
|
|
|
|
|
G. D. Laverman, G. Remuzzi, and P. Ruggenenti ACE Inhibition versus Angiotensin Receptor Blockade: Which Is Better for Renal and Cardiovascular Protection? J. Am. Soc. Nephrol., January 1, 2004; 15(90010): S64 - 70. [Abstract] [Full Text]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 L. M Ruilope, J. Segura, and E. L Schiffrin Review: ACE inhibition or angiotensin receptor blockade: which should we use in diabetic patients? Journal of Renin-Angiotensin-Aldosterone System, June 1, 2003; 4(2): 74 - 79. [Abstract] [PDF]
|
|
|
|
 |
|
 K. Nagai, H. Arai, M. Yanagita, T. Matsubara, H. Kanamori, T. Nakano, N. Iehara, A. Fukatsu, T. Kita, and T. Doi Growth Arrest-specific Gene 6 Is Involved in Glomerular Hypertrophy in the Early Stage of Diabetic Nephropathy J. Biol. Chem., May 9, 2003; 278(20): 18229 - 18234. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Wolf and E. Ritz Diabetic Nephropathy in Type 2 Diabetes Prevention and Patient Management J. Am. Soc. Nephrol., May 1, 2003; 14(5): 1396 - 1405. [Full Text] [PDF]
|
|
|
|
|
|
C. E. Mogensen, G. Viberti, S. Halimi, E. Ritz, L. Ruilope, G. Jermendy, J. Widimsky, P. Sareli, J. Taton, J. Rull, et al. Effect of Low-Dose Perindopril/Indapamide on Albuminuria in Diabetes: Preterax in Albuminuria Regression: PREMIER Hypertension, May 1, 2003; 41(5): 1063 - 1071. [Abstract] [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]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
T. H. Jafar, C. H. Schmid, M. Landa, I. Giatras, R. Toto, G. Remuzzi, G. Maschio, B. M. Brenner, A. Kamper, P. Zucchelli, et al. Angiotensin-Converting Enzyme Inhibitors and Progression of Nondiabetic Renal Disease: A Meta-Analysis of Patient-Level Data Ann Intern Med, July 17, 2001; 135(2): 73 - 87. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Fisk, R. P. Hayes, C. S. Barnes, and C. B. Cook Physician Assistant Students and Diabetes: Evaluation of Attitudes and Beliefs The Diabetes Educator, January 1, 2001; 27(1): 111 - 118. [Abstract] [PDF]
|
|
|
|
|
|
H.-H. Parving Blockade of the renin-angiotensin-aldosterone system and renal protection in diabetes mellitus Journal of Renin-Angiotensin-Aldosterone System, March 1, 2000; 1(1): 30 - 31. [PDF]
|
|
Article
