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Dual blockade of the renin-angiotensin-aldosterone system is safe and effective in reducing albuminuria in Asian type 2 diabetic patients with nephropathy.
Singapore Med J. 2010 Feb; 51(2):151-6.SM

Abstract

INTRODUCTION

Blockade of the renin-angiotensin-aldosterone system (RAAS) by either the angiotensin converting enzyme inhibitor (ACE-I) or the angiotensin II receptor blocker (ARB) has been shown to reduce albuminuria and delay the progression of diabetic nephropathy. This study evaluated the effect of dual blockade of the RAAS by adding an ACEI or an ARB to the administration of either drug alone on albuminuria in Asian type 2 diabetic patients with nephropathy.

METHODS

34 patients were randomly assigned to receive either enalapril 20 mg or losartan 100 mg once daily for eight weeks. Following this, all patients received a combination of enalapril 10 mg and losartan 50 mg daily for eight weeks, followed by enalapril 20 mg and losartan 100 mg daily for another eight weeks. The blood pressure and 24-hour urinary albumin excretion (UAE) were monitored.

RESULTS

Following monotherapy with enalapril, there was a mean and standard error (SE) reduction in the UAE and mean arterial pressure (MAP) of 9.8 (SE 6.8) percent (p-value is 0.061) and 5.3 (SE 2.2) mmHg (p-value is 0.026), respectively; the reduction in UAE and MAP following monotherapy with losartan was by 10.9 (SE 14.1) percent (p-value is 0.053) and 4.5 (SE 1.9) mmHg (p-value is 0.034), respectively. Combination therapy with enalapril and losartan further reduced the UAE (11.2 [SE 8.7] percent, p-value is 0.009] despite there being no significant change in the MAP (-1.2 [SE 1.47] mmHg, p-value is 0.42). The adverse effects included dry cough (seven [19.4 percent] patients, resulting in the withdrawal of medication in two patients), and transient hyperkalaemia (two [six percent] patients).

CONCLUSION

Dual blockade of the RAAS is safe and effective in reducing albuminuria in Asian type 2 diabetic patients with nephropathy.

Authors+Show Affiliations

Department of Medicine, Sarawak General Hospital, Jalan Tun Ahmad Zaidi Adruce, Kuching, Malaysia. ftanhs@yahoo.co.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

20358155

Citation

Tan, F, et al. "Dual Blockade of the Renin-angiotensin-aldosterone System Is Safe and Effective in Reducing Albuminuria in Asian Type 2 Diabetic Patients With Nephropathy." Singapore Medical Journal, vol. 51, no. 2, 2010, pp. 151-6.
Tan F, Mukherjee JJ, Lee KO, et al. Dual blockade of the renin-angiotensin-aldosterone system is safe and effective in reducing albuminuria in Asian type 2 diabetic patients with nephropathy. Singapore Med J. 2010;51(2):151-6.
Tan, F., Mukherjee, J. J., Lee, K. O., Lim, P., & Liew, C. F. (2010). Dual blockade of the renin-angiotensin-aldosterone system is safe and effective in reducing albuminuria in Asian type 2 diabetic patients with nephropathy. Singapore Medical Journal, 51(2), 151-6.
Tan F, et al. Dual Blockade of the Renin-angiotensin-aldosterone System Is Safe and Effective in Reducing Albuminuria in Asian Type 2 Diabetic Patients With Nephropathy. Singapore Med J. 2010;51(2):151-6. PubMed PMID: 20358155.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dual blockade of the renin-angiotensin-aldosterone system is safe and effective in reducing albuminuria in Asian type 2 diabetic patients with nephropathy. AU - Tan,F, AU - Mukherjee,J J, AU - Lee,K O, AU - Lim,P, AU - Liew,C F, PY - 2010/4/2/entrez PY - 2010/4/2/pubmed PY - 2010/7/9/medline SP - 151 EP - 6 JF - Singapore medical journal JO - Singapore Med J VL - 51 IS - 2 N2 - INTRODUCTION: Blockade of the renin-angiotensin-aldosterone system (RAAS) by either the angiotensin converting enzyme inhibitor (ACE-I) or the angiotensin II receptor blocker (ARB) has been shown to reduce albuminuria and delay the progression of diabetic nephropathy. This study evaluated the effect of dual blockade of the RAAS by adding an ACEI or an ARB to the administration of either drug alone on albuminuria in Asian type 2 diabetic patients with nephropathy. METHODS: 34 patients were randomly assigned to receive either enalapril 20 mg or losartan 100 mg once daily for eight weeks. Following this, all patients received a combination of enalapril 10 mg and losartan 50 mg daily for eight weeks, followed by enalapril 20 mg and losartan 100 mg daily for another eight weeks. The blood pressure and 24-hour urinary albumin excretion (UAE) were monitored. RESULTS: Following monotherapy with enalapril, there was a mean and standard error (SE) reduction in the UAE and mean arterial pressure (MAP) of 9.8 (SE 6.8) percent (p-value is 0.061) and 5.3 (SE 2.2) mmHg (p-value is 0.026), respectively; the reduction in UAE and MAP following monotherapy with losartan was by 10.9 (SE 14.1) percent (p-value is 0.053) and 4.5 (SE 1.9) mmHg (p-value is 0.034), respectively. Combination therapy with enalapril and losartan further reduced the UAE (11.2 [SE 8.7] percent, p-value is 0.009] despite there being no significant change in the MAP (-1.2 [SE 1.47] mmHg, p-value is 0.42). The adverse effects included dry cough (seven [19.4 percent] patients, resulting in the withdrawal of medication in two patients), and transient hyperkalaemia (two [six percent] patients). CONCLUSION: Dual blockade of the RAAS is safe and effective in reducing albuminuria in Asian type 2 diabetic patients with nephropathy. SN - 0037-5675 UR - https://www.unboundmedicine.com/medline/citation/20358155/Dual_blockade_of_the_renin_angiotensin_aldosterone_system_is_safe_and_effective_in_reducing_albuminuria_in_Asian_type_2_diabetic_patients_with_nephropathy_ L2 - http://smj.sma.org.sg/5102/5102a9.pdf DB - PRIME DP - Unbound Medicine ER -