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Title: Long-term renoprotection by perindopril or nifedipine in non-hypertensive patients with Type 2 diabetes and microalbuminuria.
Austin Authors: Jerums, George ;Allen, Terri J;Campbell, D J;Cooper, Mark E;Gilbert, Richard E;Hammond, J J;O'Brien, R C;Raffaele, J;Tsalamandris, Con
Institutional Author: Melbourne Diabetic Nephropathy Study Group
Affiliation: Department of Medicine, University of Melbourne, and Endocrinology Unit, Austin Health, Studley Road, Heidelberg, 3084 Victoria, Australia
Issue Date: 1-Nov-2004
Publication information: Diabetic Medicine : A Journal of the British Diabetic Association; 21(11): 1192-9
Abstract: To assess the efficacy of an angiotensin converting enzyme (ACE) inhibitor (perindopril), a dihydropyridine calcium channel blocker (sustained release nifedipine) and placebo in preventing the progression of albuminuria and decline in glomerular filtration rate (GFR) in patients with Type 2 diabetes and microalbuminaria.A prospective, randomized, open, blinded end point study of 77 patients allocated to three treatment groups (23 perindopril, 27 nifedipine, 27 placebo). Drug doses were adjusted to achieve a decrease in diastolic blood pressure (DBP) of 5 mmHg in the first 3 months and additional therapy was given if hypertension developed (supine DBP > 90 mmHg and/or systolic blood pressure (SBP) > 140 mmHg if < or = 40 years; supine DBP > 90 mmHg and/or SBP > 160 mmHg if > 40 years). Median follow-up was 66 months, with 37 patients being followed for at least 6 years.Blood pressure remained within the non-hypertensive range in 83% of perindopril-, 95% of nifedipine- and 30% of placebo-treated patients (P < 0.01). In the first 12 months albumin excretion rate (AER) decreased by 47% only in the perindopril group (P = 0.04). From 12 to 72 months, AER gradients increased by 27% per year only in the placebo group (P < 0.01). After 6 years, macroalbuminuria had developed in 7/15 placebo compared with 2/11 in perindopril and 1/11 nifedipine-treated patients (P = 0.05). GFR did not change in the first 12 months, but thereafter the median GFR gradient (ml/min/1.73 m(2) per year) was -2.4 (P < 0.01) for perindopril-, -1.3 (P = 0.26) for nifedipine- and -4.2 (P = 0.01) for placebo-treated patients. The rate of decline in GFR for the study group as a whole from 12 months to the end of follow-up correlated negatively with mean arterial pressure (MAP) (r = -0.38, P < 0.01). During a 3-month treatment pause in 29 patients AER tended to increase only in the perindopril group (P < 0.07).Long-term control of blood pressure with perindopril or nifedipine stabilizes AER and attenuates GFR decline in proportion to MAP in non-hypertensive patients with Type 2 diabetes and microalbuminuria.
Gov't Doc #: 15498085
DOI: 10.1111/j.1464-5491.2004.01316.x
Type: Journal Article
Subjects: Adult
Albuminuria.drug therapy.physiopathology
Angiotensin-Converting Enzyme Inhibitors.therapeutic use
Calcium Channel Blockers.therapeutic use
Diabetes Mellitus, Type 2.drug therapy.physiopathology
Diabetic Nephropathies.drug therapy.physiopathology
Disease Progression
Double-Blind Method
Glomerular Filtration Rate.drug effects
Hypertension.prevention & control
Middle Aged
Nifedipine.therapeutic use
Perindopril.therapeutic use
Prospective Studies
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