Effects of Long-Term Enalapril Treatment on Persistent Microalbuminuria in Well-Controlled Hypertensive and Normotensive NIDDM Patients

Sano, Takahisa; Kawamura, Takahiko; Matsumae, Hiromi; Sasaki, Hodaka; Nakayama, Motohiro; Hara, Tomohiro; Matsuo, Seiichi; Hotta, Nigishi; Sakamoto, Nobuo

doi:10.2337/diacare.17.5.420

Cited by 111 publications

(40 citation statements)

References 24 publications

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“…ACE inhibitors can also arrest the progression of renal dysfunction and albuminuria in type 2 diabetes (32,33). We found no difference in the usage of ACE inhibitors or calcium-channel blockers among the groups at 2 years.…”

Section: Conclusion -mentioning

confidence: 49%

Effect of intensive glycemic control on microalbuminuria in type 2 diabetes. Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type 2 Diabetes Feasibility Trial Investigators.

et al. 2000

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OBJECTIVE -Microalbuminuria can reflect the progress of microvascular complications and may be predictive of macrovascular disease in type 2 diabetes. The effect of intensive glycemic control on microalbuminuria in patients in the U.S. who have had type 2 diabetes for several years has not previously been evaluated. RESEARCH DESIGN AND METHODS-We randomly assigned 153 male patients to either intensive treatment (INT) (goal HbA 1c 7.1%) or to standard treatment (ST) (goal HbA 1c 9.1%; P = 0.001), and data were obtained during a 2-year period. Mean duration of known diabetes was 8 years, mean age of the patients was 60 years, and patients were well matched at baseline. We obtained 3-h urine samples for each patient at baseline and annually and defined microalbuminuria as an albumin:creatinine ratio of 0.03-0.30. All patients were treated with insulin and received instructions regarding diet and exercise. Hypertension and dyslipidemia were treated with similar goals in each group.RESULTS -A total of 38% of patients had microalbuminuria at entry and were evenly assigned to both treatment groups. INT retarded the progression of microalbuminuria during the 2-year period: the changes in albumin:creatinine ratio from baseline to 2 years of INT versus ST were 0.045 vs. 0.141, respectively (P = 0.046). Retardation of progressive urinary albumin excretion was most pronounced in those patients who entered the study with microalbuminuria and were randomized to INT. Patients entering with microalbuminuria had a deterioration in creatinine clearance at 2 years regardless of the intensity of glycemic control. In the group entering without microalbuminuria, the subgroup receiving ST had a lower percentage of patients with a macrovascular event (17%) than the subgroup receiving INT (36%) (P = 0.03). Use of ACE inhibitors or calcium-channel blockers was similarly distributed among the groups.CONCLUSIONS -Intensive glycemic control retards microalbuminuria in patients who have had type 2 diabetes for several years but may not lessen the progressive deterioration of glomerular function. Increases in macrovascular event rates in the subgroup entering without albuminuria who received INT remain unexplained but could reflect early worsening, as observed with microvascular disease in the Diabetes Control and Complications Trial.

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Section: Conclusion -mentioning

confidence: 49%

Effect of intensive glycemic control on microalbuminuria in type 2 diabetes. Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type 2 Diabetes Feasibility Trial Investigators.

et al. 2000

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“…The mechanism of no reduction in BP with perindopril in the present study is not understood, although several studies have reported that chronic treatment with ACE inhibitors did not change BP in wellcontrolled hypertensive or normotensive patients with DM. [22][23][24] Even in hypertensive patients, almost 30% of the patients in one study were non-responders (no significant fall in BP) to ACE inhibitors and that the fall in BP by ACE inhibitors was related to pre-treatment plasma renin activity. 25 However, we did not measure plasma renin activity, serum ACE activity or plasma angiotensin II level in this study.…”

Section: Effects Of Ace Inhibition On Adma and Vwfmentioning

confidence: 98%

Angiotensin-Converting Enzyme Activity is Involved in the Mechanism of Increased Endogenous Nitric Oxide Synthase Inhibitor in Patients With Type 2 Diabetes Mellitus.

Itō

Egashira

Narishige

et al. 2002

Circ J

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“…HbA1c, TC, such management is hardly effective in the advanced stage. Angiotensin converting enzyme inhibitor (ACEI) [1][2][3][4][5] and angiotensin Ⅱ receptor blocker (ARB) [6][7][8] were reported to have beneficial effects on diabetic nephropathy; however, the number of patients initiated on hemodialysis due to diabetic nephropathy continues to increase year by year. In Japan, the number of patients on hemodialysis therapy was approximately 300,000 in 2009, and nearly half were patients with diabetic nephropathy; therefore, preventive therapy is urgently required.…”

Section: Blood and Urine Samplingmentioning

confidence: 99%

Probucol Suppresses Initiation of Chronic Hemodialysis Therapy and Renal Dysfunction-Related Death in Diabetic Nephropathy Patients: Sakura Study

Endo

Saiki

Yamaguchi

et al. 2013

JAT

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Aim: Probucol has antioxidant as well as cholesterol-lowering effects. We examined the effect of probucol on the progression of diabetic nephropathy. We named this study 'Sakura Study' after our hospital and city. Methods: We performed a randomized, open trial on 162 type 2 diabetic patients with clinical albuminuria (urinary albumin excretion ＞300 mg/g creatinine). Eighty patients were assigned to probucol treatment (500 mg/day) and 82 patients to no probucol treatment. All patients were followed for five years. The primary outcome was the time to renal dysfunction events, defined as the initiation of chronic hemodialysis therapy and renal dysfunction-related death. Results: Probucol decreased total cholesterol, HDL-cholesterol, and LDL-cholesterol compared to the control group. The serum creatinine increase rate was significantly lower (p = 0.015) in the probucol group (0.066 mg/dL/month) than in the non-probucol group (0.116 mg/dL/month). Renal dysfunction events occurred in 72 patients during this study. The 69 patients who were initiated on chronic hemodialysis comprised 42 in the non-probucol group and 27 in the probucol group. Three patients in the non-probucol group, but no patients in the probucol group died of renal dysfunction. The renal dysfunction event-free survival rate was significantly higher (log-rank: p = 0.02) in the probucol group than in the non-probucol group. Conclusion: Probucol suppressed the progression of diabetic nephropathy and renal dysfunction events.

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Effects of Long-Term Enalapril Treatment on Persistent Microalbuminuria in Well-Controlled Hypertensive and Normotensive NIDDM Patients

Abstract: Treatment with enalapril for 48 months may have a beneficial effect on the decline of microalbumin excretion in NIDDM patients.

Cited by 111 publications

References 24 publications

Effect of intensive glycemic control on microalbuminuria in type 2 diabetes. Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type 2 Diabetes Feasibility Trial Investigators.

Effect of intensive glycemic control on microalbuminuria in type 2 diabetes. Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type 2 Diabetes Feasibility Trial Investigators.

Angiotensin-Converting Enzyme Activity is Involved in the Mechanism of Increased Endogenous Nitric Oxide Synthase Inhibitor in Patients With Type 2 Diabetes Mellitus.

Probucol Suppresses Initiation of Chronic Hemodialysis Therapy and Renal Dysfunction-Related Death in Diabetic Nephropathy Patients: Sakura Study

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