Contrasting effects of enalapril and metoprolol on proteinuria in diabetic nephropathy.

Björck, S; Mulec, H.; Johnsen, Svend Aage; Nyberg, Gudrun; Aurell, Mattias

doi:10.1136/bmj.300.6729.904

Cited by 123 publications

(40 citation statements)

References 18 publications

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“…This effect has since been confirmed by other investigators (Morgensen 1982; Bjorck et al 1990Bjorck et al , 1992. However, it has not been established whether blood pressure control has a consistent effect on the progression of diabetic nephropathy in patients with macroalbuminuria and differing serum creatinine levels.…”

supporting

confidence: 48%

Do the Effects of Blood Pressure Control on the Progression of Diabetic Nephropathy Depend on Disease Stage ?

Kubo

Ito

Nakamura

et al. 1995

Tohoku J. Exp. Med.

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supporting

confidence: 48%

Do the Effects of Blood Pressure Control on the Progression of Diabetic Nephropathy Depend on Disease Stage ?

Kubo

Ito

Nakamura

et al. 1995

Tohoku J. Exp. Med.

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“…More recent randomised controlled studies have suggested that intervention targeting the renin-angiotensin system is particularly renoprotective, i.e. preserves renal function above and beyond the effect of lowering blood pressure [34,35].…”

Section: The Changing Course Of Diabetic Kidney Diseasementioning

confidence: 99%

The changing epidemiology of diabetic microangiopathy in type 1 diabetes

Rossing

2005

Diabetologia

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Diabetic microvascular complications in the kidney and the eye are a major burden for diabetic patients due to increased morbidity and mortality. Furthermore, diabetic nephropathy is the leading cause of end-stage renal disease and diabetic retinopathy is the leading cause of blindness in younger patients, representing a major public health concern. During the past two decades beneficial effects of, in particular, aggressive antihypertensive control and strict glycaemic control have been demonstrated in randomised controlled clinical trials. Technological improvements in diabetes care have made good metabolic control easier to achieve. Has this led to an improved prognosis? In observational studies from dedicated centres, a decrease from 47 to 13% has been reported in the incidence of proliferative diabetic retinopathy after 20-25 years of diabetes, and the incidence of overt diabetic nephropathy after 20 years has decreased from 28 to 5.8%. Even functional and morphological remission of diabetic nephropathy has been reported. Despite this, recent population-based studies have failed to demonstrate a decrease in the incidence of blindness caused by diabetes, and the incidence of end-stage renal disease has progressively increased. This may, in part, be the result of a combination of increasing numbers of diabetic patients and a lag phase between improvement in management and a decline in end-stage complications. It is of concern, however, that the results from specialised centres may not apply to routine diabetes care. It is, therefore, mandatory that the beneficial effects of pharmacological and non-pharmacological interventions demonstrated in clinical trials and recommended by treatment guidelines are translated into clinical practice to ensure a widespread improvement in prognosis.

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“…21 Concerning the choice of antihypertensive agents, a new argument was introduced by some studies sug gesting disparate renal protective effects of different antihypertensive drugs in diabetic animals ' 25 and humans. 26 In an attempt to resolve the controversy around this possibility, we reported a meta-analysis of published studies in diabetics with microalbumin uria or overt proteinuria treated with conventional agents, angiotensin-converting enzyme (ACE) inhib itors, or Ca 2+ antagonists. 27,28 Here, we present an updated meta-analysis of treatment-effects concern ing not only proteinuria but also GFR.…”

mentioning

confidence: 99%

Comparative Study of the Effect of Ace Inhibitors and other Antihypertensive Agents on Proteinuria in Diabetic Patients

Böhlen¹,

Schneider²,

Courten³

et al. 1996

The Kidney and Hypertension in Diabetes Mellitus

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Several studies during the past 15 years have shown that antihypertensive therapy with different types of drugs can reduce microalbuminuria or clinical proteinuria and retard the progression to ward end-stage renal failure. However, some au thors reported disparate renal protective effects of different antihypertensive drugs in diabetic ani mals and humans. In an attempt to resolve the controversy surrounding this possibility, previ ously we reported a meta-analysis of published studies in diabetics with microalbuminuria or overt proteinuria treated with conventional agents, angiotensin-converting enzyme (ACE) inhibitors, or calcium antagonists (Ca 2+ antagonists). Here we present an updated meta-analysis of published studies in diabetics with microalbuminuria or clin ical proteinuria (UProt), treated during >4 weeks with ACE inhibitors, Ca 2+ antagonists, or conven tional therapy (diuretic and/or β-blocker). Despite similar blood pressure (BP) reductions, UProt tended to decrease more on ACE inhibitors (on av erage -45%) than on conventional therapy (on av erage -23%) or Ca 2+ antagonists other than nifed ipine (on average -35%); in contrast, UProt tended to increase slightly on nifedipine (on average 5%, Ρ < .05). On the basis of multiple regression anal ysis, ACE inhibitor-induced UProt changes corre lated with BP changes (r = 0.77, Ρ < .00001), aver aged -28% at zero BP change, and varied 1.5% for each percent BP change. On conventional therapy, UProt and BP changes also correlated (r = 0.62, Ρ < .005), but UProt began to decrease only after a BP reduction of >5% and the slope was steeper (4% UProt change per percent BP change) than on ACE inhibitors. On Ca 2+ antagonists other than nifedipine, UProt was unchanged at zero BP change, and the regression line for the relationship between changes in UProt (r = 0.55, Ρ < .05) was in an intermediate position between ACE inhibi tors and conventional treatment. Seventy reports also contained data on glomerular filtration rate (GFR). On ACE inhibitors, GFR was on average unchanged, but tended to increase slighty with progressive BP reduction (r = -0.55, Ρ < .0001). On conventional therapy or Ca 2+ .antagonists, vari ations in GFR were unrelated to changes in BP.As ACE inhibitors exert a specific antiproteinuric effect even without a change in systemic BP, they are superior to other agents in treating microalbu minuria or overt proteinuria in initially normoten sive or mildly hypertensive diabetic patients. On the other hand, when systemic BP can be lowered by 20%, as it is desirable in severely hypertensive patients, ACE inhibitors, conventional therapy, and several Ca 2+ antagonists all have a distinct an tiproteinuric action. In contrast, as the example of nifedipine illustrates, drug-specific intrarenal ef fects may antagonize a BP-dependent antiproteinu ric action and even counteract the effect of lower ing systemic pressure. It is of note that ACE inhib itors may, in addition to their antiproteinuric effect, exert a drug-specific beneficial influence on GFR. Am ...

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Contrasting effects of enalapril and metoprolol on proteinuria in diabetic nephropathy.

Cited by 123 publications

References 18 publications

Do the Effects of Blood Pressure Control on the Progression of Diabetic Nephropathy Depend on Disease Stage ?

Do the Effects of Blood Pressure Control on the Progression of Diabetic Nephropathy Depend on Disease Stage ?

The changing epidemiology of diabetic microangiopathy in type 1 diabetes

Comparative Study of the Effect of Ace Inhibitors and other Antihypertensive Agents on Proteinuria in Diabetic Patients

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