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Antihypertensive Therapy for Diabetic Patients Without Albuminuria

In this trial, an ACE inhibitor slowed development of microalbuminuria, but a CCB did not.

Angiotensin-converting-enzyme (ACE) inhibitors delay progression of microalbuminuria in type 2 diabetic patients; weaker evidence suggests that non-dihydropyridine calcium-channel blockers (CCBs) also exert this effect. But do these drugs prevent the new onset of microalbuminuria in hypertensive type 2 diabetic patients?

Italian researchers randomized 1204 hypertensive patients with type 2 diabetes, no microalbuminuria, and serum creatinine levels 1.5 mg/dL to receive the ACE inhibitor trandolapril, the CCB verapamil, both drugs, or placebo. Other drugs were added, if necessary, to control blood pressure. The study was supported by a maker of trandolapril and verapamil.

During a median follow-up of 3.6 years, persistent microalbuminuria developed in 5.7% of combination-therapy recipients, 6.0% of trandolapril recipients, 10% of placebo recipients, and 11.9% of verapamil recipients. Trandolapril alone was as effective as combination therapy, and both of these were superior to verapamil alone and to placebo. Differences between groups in blood pressure control were minimal, and adverse event rates were similar.

Comment: In this trial, the ACE inhibitor trandolapril prevented the development of microalbuminuria during several years of treatment in about 1 of 20 patients. The CCB verapamil conferred no such benefit, either alone or when added to trandolapril. Although these findings support ACE inhibitors as first-line drugs for hypertension in diabetic patients without albuminuria, keep in mind that this study did not address the long-term endpoint of advanced nephropathy.

— Allan S. Brett, MD

Published in Journal Watch General Medicine November 12, 2004

Citation(s):

Ruggenenti P et al. Preventing microalbuminuria in type 2 diabetes. N Engl J Med 2004 Nov 4; 351:1941-51.

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