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Effects of dual blockade of renin-angiotensin system in type 2 diabetes mellitus patients with diabetic nephropathy.
J Med Assoc Thai. 2009 May; 92(5):611-7.JM

Abstract

BACKGROUND

Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB) have been shown to delay the progression to proteinuria and kidney failure in hypertensive type 2 diabetic patients with diabetic nephropathy. Further synergistic effect may be obtained by combined therapy with both ARB and ACE inhibitors.

OBJECTIVE

To evaluate the effect of dual blockage of the renin-angiotensin system by adding maximal recommended dose of ARB with maximal recommended dose of ACE inhibitors in type 2 diabetic patients with diabetic nephropathy.

MATERIAL AND METHOD

Type 2 diabetic patients with urine protein/creatinine (UPCr) > 0.5 gm/gm and hypertension who received maximal recommended dose of ACE inhibitors (Enalapril 40 mg/day) over three months were randomized to two groups. ARB group received adding maximal recommended dose of ARB (Telmisartan 80 mg/day) and control group received previous ACE inhibitors only for 24 weeks.

RESULTS

Eighty patients were enrolled. ARB group led to significantly reduced UPCr from baseline at week 8, 12, and 24 (2.65 +/- 1.81, 2.24 +/- 1.85, 2.24 +/- 1.88 and 1.98 +/- 1.73 gm/gm respectively, p < 0.05) but UPCr in the control group was unchanged (1.97 +/- 1.56, 1.85 +/- 1.27, 1.97 +/- 1.11 and 1.96 +/- 1.42 gm/gm respectively, p > 0.05). ARB group induced an additional reduction in proteinuria of 29.25% (95% CI 9.68-48.82) compared with control group. By the end of the present study, glomerular filtration rate had fallen from 41.76 +/- 12.16 to 37.84 +/- 13.59 ml/min/1.73 m2 in ARB group and 50.89 +/- 29.43 to 49.41 +/- 29.85 ml/min/1.73 m2 in control group (p > 0.05). Serum potassium had changed from 4.51 +/- 0.48 to 4.58 +/- 0.13 mEq/L in ARB group and 4.60 +/- 0.58 to 4.40 +/- 0.13 mEq/L in the control group (p > 0.05). No other serious adverse effects were reported during treatment.

CONCLUSION

Adding maximal recommended dose of ARB with maximal recommended dose of ACE inhibitors in type 2 diabetic patients can reduce proteinuria more than ACE inhibitors alone. This treatment is safe and well tolerated.

Authors+Show Affiliations

Krairittichai U
Department of Medicine, Rajavithi Hospital, Institute of Undergraduate Medical Education, Department of Medical Services in Affiliation with Rangsit University, Bangkok, Thailand. krairit@yahoo.com
Chaisuvannarat V
No affiliation info available

MeSH

AdultAgedAnalysis of VarianceAngiotensin II Type 1 Receptor BlockersAngiotensin-Converting Enzyme InhibitorsAntihypertensive AgentsBenzimidazolesBenzoatesBlood PressureDiabetes Mellitus, Type 2Diabetic NephropathiesDisease ProgressionDrug SynergismDrug Therapy, CombinationEnalaprilFemaleHumansMaleMiddle AgedProteinuriaRenin-Angiotensin SystemTelmisartanTreatment Outcome

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19459520

Citation

Krairittichai, Udom, and Viranya Chaisuvannarat. "Effects of Dual Blockade of Renin-angiotensin System in Type 2 Diabetes Mellitus Patients With Diabetic Nephropathy." Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, vol. 92, no. 5, 2009, pp. 611-7.
Krairittichai U, Chaisuvannarat V. Effects of dual blockade of renin-angiotensin system in type 2 diabetes mellitus patients with diabetic nephropathy. J Med Assoc Thai. 2009;92(5):611-7.
Krairittichai, U., & Chaisuvannarat, V. (2009). Effects of dual blockade of renin-angiotensin system in type 2 diabetes mellitus patients with diabetic nephropathy. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, 92(5), 611-7.
Krairittichai U, Chaisuvannarat V. Effects of Dual Blockade of Renin-angiotensin System in Type 2 Diabetes Mellitus Patients With Diabetic Nephropathy. J Med Assoc Thai. 2009;92(5):611-7. PubMed PMID: 19459520.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of dual blockade of renin-angiotensin system in type 2 diabetes mellitus patients with diabetic nephropathy. AU - Krairittichai,Udom, AU - Chaisuvannarat,Viranya, PY - 2009/5/23/entrez PY - 2009/5/23/pubmed PY - 2009/6/24/medline SP - 611 EP - 7 JF - Journal of the Medical Association of Thailand = Chotmaihet thangphaet JO - J Med Assoc Thai VL - 92 IS - 5 N2 - BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB) have been shown to delay the progression to proteinuria and kidney failure in hypertensive type 2 diabetic patients with diabetic nephropathy. Further synergistic effect may be obtained by combined therapy with both ARB and ACE inhibitors. OBJECTIVE: To evaluate the effect of dual blockage of the renin-angiotensin system by adding maximal recommended dose of ARB with maximal recommended dose of ACE inhibitors in type 2 diabetic patients with diabetic nephropathy. MATERIAL AND METHOD: Type 2 diabetic patients with urine protein/creatinine (UPCr) > 0.5 gm/gm and hypertension who received maximal recommended dose of ACE inhibitors (Enalapril 40 mg/day) over three months were randomized to two groups. ARB group received adding maximal recommended dose of ARB (Telmisartan 80 mg/day) and control group received previous ACE inhibitors only for 24 weeks. RESULTS: Eighty patients were enrolled. ARB group led to significantly reduced UPCr from baseline at week 8, 12, and 24 (2.65 +/- 1.81, 2.24 +/- 1.85, 2.24 +/- 1.88 and 1.98 +/- 1.73 gm/gm respectively, p < 0.05) but UPCr in the control group was unchanged (1.97 +/- 1.56, 1.85 +/- 1.27, 1.97 +/- 1.11 and 1.96 +/- 1.42 gm/gm respectively, p > 0.05). ARB group induced an additional reduction in proteinuria of 29.25% (95% CI 9.68-48.82) compared with control group. By the end of the present study, glomerular filtration rate had fallen from 41.76 +/- 12.16 to 37.84 +/- 13.59 ml/min/1.73 m2 in ARB group and 50.89 +/- 29.43 to 49.41 +/- 29.85 ml/min/1.73 m2 in control group (p > 0.05). Serum potassium had changed from 4.51 +/- 0.48 to 4.58 +/- 0.13 mEq/L in ARB group and 4.60 +/- 0.58 to 4.40 +/- 0.13 mEq/L in the control group (p > 0.05). No other serious adverse effects were reported during treatment. CONCLUSION: Adding maximal recommended dose of ARB with maximal recommended dose of ACE inhibitors in type 2 diabetic patients can reduce proteinuria more than ACE inhibitors alone. This treatment is safe and well tolerated. SN - 0125-2208 UR - https://www.unboundmedicine.com/medline/citation/19459520/Effects_of_dual_blockade_of_renin_angiotensin_system_in_type_2_diabetes_mellitus_patients_with_diabetic_nephropathy_ L2 - http://www.diseaseinfosearch.org/result/8215 DB - PRIME DP - Unbound Medicine ER -