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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
The Blood Pressure Drug Losartan Appears To Benefit the Kidneys of People with Type 2 Diabetes Who Do Not Have High Blood Pressure
15 July 2003 | Volume 139 Issue 2 | Page I-24
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 "Effect of Losartan on Microalbuminuria in Normotensive Patients with Type 2 Diabetes Mellitus. A Randomized Clinical Trial." It is in the 15 July 2003 issue of Annals of Internal Medicine (volume 139, pages 90-96). The authors are A.A.M. Zandbergen, M.G.A. Baggen, S.W.J. Lamberts, A.H. Bootsma, D. de Zeeuw, and R.J.Th. Ouwendijk.
What is the problem and what is known about it so far?
Type 2 diabetes mellitus interferes with the body's ability to use insulin, a substance created by the pancreas to store energy from food. In people with type 2 diabetes, the body makes plenty of insulin but can't use it normally. The result is high blood sugar levels. Over time, high blood sugar can lead to complications, including kidney problems. Diabetes is the most common cause of kidney failure in the United States. Good control of blood sugar and blood pressure delays the development of kidney problems in people with type 2 diabetes. Blood pressure drugs called angiotensin-converting enzyme inhibitors also protect people with type 2 diabetes against kidney problems. This benefit occurs whether or not people also have high blood pressure. Another type of blood pressure drug called angiotensin-receptor antagonists (AR antagonists) protects against kidney problems in people who have both type 2 diabetes and high blood pressure. However, we don't know if AR antagonists protect the kidneys in people with type 2 diabetes and normal blood pressure.
Why did the researchers do this particular study?
To see whether AR antagonists protect the kidneys of people with type 2 diabetes and normal blood pressure.
Who was studied?
149 patients from medical centers in the Netherlands who had type 2 diabetes, had a blood pressure of 150/90 mm Hg or less, and were not receiving any blood pressure drugs. All the patients had microalbuminuria, an early sign of kidney disease in which the kidneys leak small amounts of the protein albumin into the urine.
How was the study done?
The researchers assigned patients at random to take either the AR antagonist losartan or a placebo pill. The placebo pill was similar to losartan but contained no active ingredients. Using blood and urine tests, the researchers measured the amount of albumin that leaked into urine after 5 and 10 weeks. More albumin indicates worse kidney function.
What did the researchers find?
At both 5 and 10 weeks, patients receiving losartan had more favorable changes in albumin measurements than did patients receiving placebo.
What were the limitations of the study?
Albumin is only a rough laboratory test for how well the kidneys are working. The study was too small and too short to show any differences in the development of kidney disease.
What are the implications of the study?
Angiotensin-receptor antagonists such as losartan deserve further study as a way to protect against kidney disease in patients with type 2 diabetes and normal blood pressure.
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  R. Kunz, C. Friedrich, M. Wolbers, and J. F.E. Mann Meta-analysis: Effect of Monotherapy and Combination Therapy with Inhibitors of the Renin-Angiotensin System on Proteinuria in Renal Disease Ann Intern Med, January 1, 2008; 148(1): 30 - 48. [Abstract] [Full Text] [PDF]
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 A. A.M. Zandbergen, L. Vogt, D. de Zeeuw, S. W.J. Lamberts, R. J.T.H. Ouwendijk, M. G.A. Baggen, and A. H. Bootsma Change in Albuminuria Is Predictive of Cardiovascular Outcome in Normotensive Patients With Type 2 Diabetes and Microalbuminuria Diabetes Care, December 1, 2007; 30(12): 3119 - 3121. [Full Text] [PDF]
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 A. A M Zandbergen, S. W J Lamberts, J. A M J L Janssen, and A. H Bootsma Short-term administration of an angiotensin-receptor antagonist in patients with impaired fasting glucose improves insulin sensitivity and increases free IGF-I. Eur. J. Endocrinol., August 1, 2006; 155(2): 293 - 296. [Abstract] [Full Text] [PDF]
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A. A.M. Zandbergen, E. J. Sijbrands, S. W. Lamberts, and A. H. Bootsma Normotensive Women With Type 2 Diabetes and Microalbuminuria Are at High Risk for Macrovascular Disease Diabetes Care, August 1, 2006; 29(8): 1851 - 1855. [Abstract] [Full Text] [PDF]
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 S. B. Leichter Continuing Medical Education in Diabetes: The Impending Crisis Clin. Diabetes, October 1, 2004; 22(4): 174 - 177. [Full Text] [PDF]
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K. Kario and K. Shimada Losartan for Microalbuminuria in Normotensive Type 2 Diabetes Mellitus Ann Intern Med, April 20, 2004; 140(8): 668 - 668. [Full Text] [PDF]
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A. K. Mandal Losartan for Microalbuminuria in Normotensive Type 2 Diabetes Mellitus Ann Intern Med, April 20, 2004; 140(8): 667 - 668. [Full Text] [PDF]
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 Other articles noted: 25 Jul 03 to 7 Nov 03 Evid. Based Nurs., January 1, 2004; 7(1): e1 - 1. [Full Text] [PDF]
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