 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Effects of Blood Pressure Drugs in Patients with Diabetes and Kidney Disease
1 April 2003 | Volume 138 Issue 7 | Page I-43
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full report titled "Cardiovascular Outcomes in the Irbesartan Diabetic Nephropathy Trial of Patients with Type 2 Diabetes and Overt Nephropathy." It is in the 1 April 2003 issue of Annals of Internal Medicine (volume 138, pages 542-549). The authors are T. Berl, L.G. Hunsicker, J.B. Lewis, M.A. Pfeffer, J.G. Porush, J.-L. Rouleau, P.L. Drury, E. Esmatjes, D. Hricik, C.R. Parikh, I. Raz, P. Vanhille, T.B. Wiegmann, B.M. Wolfe, F. Locatelli, S.Z. Goldhaber, and E.J. Lewis, for the Collaborative Study Group.
What is the problem and what is known about it so far?
Diabetes is characterized by persistent elevations in blood sugar. It is one of the most common chronic diseases in the United States and it increases risks for heart disease and stroke (cardiovascular disease). Diabetes often affects the kidneys and causes protein to leak into the urine, a condition called diabetic nephropathy. Many adults with diabetic nephropathy also have high blood pressure. Several different drugs, called antihypertensive agents, can lower blood pressure. Although these agents help prevent cardiovascular disease, we do not know which ones work best in adults with diabetic nephropathy.
Why did the researchers do this particular study?
To compare effects of an angiotensin-receptor blocker (irbesartan) and a calcium-channel blocker (amlodipine) on cardiovascular disease in adults with diabetic nephropathy.
Who was studied?
1715 adults with diabetes, nephropathy, and high blood pressure.
How was the study done?
The researchers randomly assigned patients to begin blood pressure treatment with irbesartan, amlodipine, or a dummy pill (placebo). Neither the patients nor their doctors were told who got which treatment. The researchers often measured each patient's blood pressure. They aimed to lower each person's blood pressure to less than 135/85 mm Hg. Other drugs were added as necessary to control blood pressure. The researchers followed patients for about 2.5 years to see if any patients had strokes or heart disease (heart attacks; heart failure; or coronary artery procedure, such as bypass surgery or stenting).
What did the researchers find?
Most patients in all three groups needed at least three drugs to control their blood pressure. On average, patients who started treatment with either irbesartan or amlodipine achieved blood pressures of about 140/77 mg Hg. On average, patients who started treatment with the dummy pill achieved blood pressures of about 144/80 mg Hg. Overall, the total numbers of patients with cardiovascular disease did not vary between the three groups. However, patients who started treatment with amlodipine had heart attacks less often than patients who started treatment with the dummy pill. Also, patients who started treatment with irbesartan had heart failure less often than patients in the other two groups.
What were the limitations of the study?
It was difficult to sort out effects of individual drugs (irbesartan and amlodipine) because most patients needed several drugs for blood pressure control. The researchers also had limited ability to detect differences in numbers of strokes between groups because few patients had strokes.
What are the implications of the study?
In patients with diabetic nephropathy, starting antihypertensive therapy with either amlodipine or irbesartan has no clear difference in preventing cardiovascular disease.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  American Diabetes Association Standards of Medical Care in Diabetes--2008 Diabetes Care, January 1, 2008; 31(Supplement_1): S12 - S54. [Full Text] [PDF]
|
|
|
|
 |
|
 R. E. Gilbert Rosiglitazone: Opening Pandora's Black Box? Clin. J. Am. Soc. Nephrol., November 1, 2007; 2(6): 1329 - 1331. [Full Text] [PDF]
|
|
|
|
 |
|
 A. D. Naik, T. T. Issac, R. L. Street Jr, and M. E. Kunik Understanding the Quality Chasm for Hypertension Control in Diabetes: A Structured Review of "Co-maneuvers" Used in Clinical Trials J Am Board Fam Med, September 1, 2007; 20(5): 469 - 478. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. D. Marciante, J. C. Bis, M. J. Rieder, A. P. Reiner, T. Lumley, S. A. Monks, C. Kooperberg, C. Carlson, S. R. Heckbert, and B. M. Psaty Renin-Angiotensin System Haplotypes and the Risk of Myocardial Infarction and Stroke in Pharmacologically Treated Hypertensive Patients Am. J. Epidemiol., July 1, 2007; 166(1): 19 - 27. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
American Diabetes Association Standards of Medical Care in Diabetes--2007 Diabetes Care, January 1, 2007; 30(suppl_1): S4 - S41. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Ruggenenti, A. Perna, M. Ganeva, B. Ene-Iordache, G. Remuzzi, and for the BENEDICT Study Group Impact of Blood Pressure Control and Angiotensin-Converting Enzyme Inhibitor Therapy on New-Onset Microalbuminuria in Type 2 Diabetes: A Post Hoc Analysis of the BENEDICT Trial J. Am. Soc. Nephrol., December 1, 2006; 17(12): 3472 - 3481. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. A Howard, J. W. Cheng, M. A Crouch, V. J Colucci, J. S Kalus, S. A Spinler, and M. Munger Drug Therapy Recommendations from the 2005 ACC/AHA Guidelines for Treatment of Chronic Heart Failure Ann. Pharmacother., September 1, 2006; 40(9): 1607 - 1616. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. T. Tsuyuki and M. A. McDonald Response to Tsuyuki and McDonald Circulation, August 22, 2006; 114(8): 855 - 860. [Full Text] [PDF]
|
|
|
|
|
|
P. S. Sever, N. R. Poulter, W. J. Elliott, M. C. Jonsson, H. R. Black, P. S. Sever, N. R. Poulter, W. J. Elliott, M. C. Jonsson, and H. R. Black Blood Pressure Reduction Is Not the Only Determinant of Outcome Circulation, June 13, 2006; 113(23): 2754 - 2774. [Full Text] [PDF]
|
|
|
|
|
|
G. Remuzzi, M. Macia, and P. Ruggenenti Prevention and Treatment of Diabetic Renal Disease in Type 2 Diabetes: The BENEDICT Study J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S90 - S97. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. E. Gilbert, K. Connelly, D. J. Kelly, C. A. Pollock, and H. Krum Heart Failure and Nephropathy: Catastrophic and Interrelated Complications of Diabetes Clin. J. Am. Soc. Nephrol., March 1, 2006; 1(2): 193 - 208. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Rahman, S. Pressel, B. R. Davis, C. Nwachuku, J. T. Wright Jr., P. K. Whelton, J. Barzilay, V. Batuman, J. H. Eckfeldt, M. A. Farber, et al. Cardiovascular Outcomes in High-Risk Hypertensive Patients Stratified by Baseline Glomerular Filtration Rate Ann Intern Med, February 7, 2006; 144(3): 172 - 180. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Berl and W. Henrich Kidney-Heart Interactions: Epidemiology, Pathogenesis, and Treatment Clin. J. Am. Soc. Nephrol., January 1, 2006; 1(1): 8 - 18. [Full Text] [PDF]
|
|
|
|
|
|
American Diabetes Association Standards of Medical Care in Diabetes-2006 Diabetes Care, January 1, 2006; 29(suppl_1): S4 - S42. [Full Text] [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]
|
|
|
|
|
|
A. N. Friedman, L. G. Hunsicker, J. Selhub, A. G. Bostom, and for the Collaborative Study Group Total Plasma Homocysteine and Arteriosclerotic Outcomes in Type 2 Diabetes with Nephropathy J. Am. Soc. Nephrol., November 1, 2005; 16(11): 3397 - 3402. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A McDonald, S. H Simpson, J. A Ezekowitz, G. Gyenes, and R. T Tsuyuki Angiotensin receptor blockers and risk of myocardial infarction: systematic review BMJ, October 15, 2005; 331(7521): 873. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Pohl, S. Blumenthal, D. J. Cordonnier, F. De Alvaro, G. DeFerrari, G. Eisner, E. Esmatjes, R. E. Gilbert, L. G. Hunsicker, J. B. L. de Faria, et al. Independent and Additive Impact of Blood Pressure Control and Angiotensin II Receptor Blockade on Renal Outcomes in the Irbesartan Diabetic Nephropathy Trial: Clinical Implications and Limitations J. Am. Soc. Nephrol., October 1, 2005; 16(10): 3027 - 3037. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Developed in Collaboration With the American Colle, Endorsed by the Heart Rhythm Society, S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure) J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1116 - 1143. [Full Text] [PDF]
|
|
|
|
|
|
S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, K. Michl, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: Endorsed by the Heart Rhythm Society Circulation, September 20, 2005; 112(12): 1825 - 1852. [Full Text] [PDF]
|
|
|
|
|
|
J. Arnlov, J. C. Evans, J. B. Meigs, T. J. Wang, C. S. Fox, D. Levy, E. J. Benjamin, R. B. D'Agostino, and R. S. Vasan Low-Grade Albuminuria and Incidence of Cardiovascular Disease Events in Nonhypertensive and Nondiabetic Individuals: The Framingham Heart Study Circulation, August 16, 2005; 112(7): 969 - 975. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Verdecchia, G. Reboldi, F. Angeli, R. Gattobigio, M. Bentivoglio, L. Thijs, J. A. Staessen, and C. Porcellati Angiotensin-Converting Enzyme Inhibitors and Calcium Channel Blockers for Coronary Heart Disease and Stroke Prevention Hypertension, August 1, 2005; 46(2): 386 - 392. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Chiarelli, D. Di Marzio, F. Santilli, A. Mohn, A. Blasetti, F. Cipollone, A. Mezzetti, and A. Verrotti Effects of Irbesartan on Intracellular Antioxidant Enzyme Expression and Activity in Adolescents and Young Adults With Early Diabetic Angiopathy Diabetes Care, July 1, 2005; 28(7): 1690 - 1697. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Berl, L. G. Hunsicker, J. B. Lewis, M. A. Pfeffer, J. G. Porush, J.-L. Rouleau, P. L. Drury, E. Esmatjes, D. Hricik, M. Pohl, et al. Impact of Achieved Blood Pressure on Cardiovascular Outcomes in the Irbesartan Diabetic Nephropathy Trial J. Am. Soc. Nephrol., July 1, 2005; 16(7): 2170 - 2179. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Blood Pressure Lowering Treatment Trialists' Colla Effects of Different Blood Pressure-Lowering Regimens on Major Cardiovascular Events in Individuals With and Without Diabetes Mellitus: Results of Prospectively Designed Overviews of Randomized Trials Arch Intern Med, June 27, 2005; 165(12): 1410 - 1419. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. McMurray Angiotensin receptor blockers and myocardial infarction: Analysis of evidence is incomplete and inaccurate BMJ, May 28, 2005; 330(7502): 1269 - 1269. [Full Text] [PDF]
|
|
|
|
|
|
E. J Lewis and on behalf of the Collaborative Study Group Angiotensin receptor blockers and myocardial infarction: Results reflect different cardiovascular states in patients with types 1 and 2 diabetes BMJ, May 28, 2005; 330(7502): 1269 - 1270. [Full Text]
|
|
|
|
|
|
B. J Epstein and J. G Gums Angiotensin Receptor Blockers versus ACE Inhibitors: Prevention of Death and Myocardial Infarction in High-Risk Populations Ann. Pharmacother., March 1, 2005; 39(3): 470 - 480. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
American Diabetes Association Standards of Medical Care in Diabetes Diabetes Care, January 1, 2005; 28(suppl_1): S4 - S36. [Full Text] [PDF]
|
|
|
|
|
|
Z. T. Bloomgarden Diabetes Complications Diabetes Care, June 1, 2004; 27(6): 1506 - 1514. [Full Text] [PDF]
|
|
|
|
|
|
B. M. Brenner Regarding: "Management of Glomerular Proteinuria: A Commentary" J. Am. Soc. Nephrol., May 1, 2004; 15(5): 1354 - 1355. [Full Text] [PDF]
|
|
|
|
|
|
E. J. Lewis and J. B. Lewis ACE Inhibitors versus Angiotensin Receptor Blockers in Diabetic Nephropathy: Is There a Winner? J. Am. Soc. Nephrol., May 1, 2004; 15(5): 1358 - 1360. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Trenkwalder Antihypertensive treatment with calcium channel blockers: pharmacological pornography or useful intervention? Nephrol. Dial. Transplant., January 1, 2004; 19(1): 17 - 20. [Full Text] [PDF]
|
|
|
|
|
|
Standards of Medical Care in Diabetes Diabetes Care, January 1, 2004; 27(90001): s15 - 35. [Full Text] [PDF]
|
|
|
|
|
|
T. Berl Angiotensin-Converting Enzyme Inhibitors versus AT1 Receptor Antagonist in Cardiovascular and Renal Protection: The case for AT1 Receptor Antagonist J. Am. Soc. Nephrol., January 1, 2004; 15(90010): S71 - 76. [Abstract] [Full Text]
|
|
|
|
|
|
W. A. Wilmer, B. H. Rovin, C. J. Hebert, S. V. Rao, K. Kumor, and L. A. Hebert Management of Glomerular Proteinuria: A Commentary J. Am. Soc. Nephrol., December 1, 2003; 14(12): 3217 - 3232. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Malik JournalScan Heart, July 1, 2003; 89(7): 815 - 816. [Full Text] [PDF]
|
|
|
|
 |
|
 Treatment of Hypertension in Patients with Type 2 Diabetes Journal Watch Gastroenterology, May 28, 2003; 2003(528): 7 - 7. [Full Text]
|
|
|
|
 |
|
 Treatment of Hypertension in Patients with Type 2 Diabetes Journal Watch Cardiology, May 16, 2003; 2003(516): 4 - 4. [Full Text]
|
|
|
|
 |
|
 Treatment of Hypertension in Patients with Type 2 Diabetes Journal Watch (General), April 29, 2003; 2003(429): 1 - 1. [Full Text]
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Article
