Long-term effects of ramipril and nitrendipine on albuminuria in hypertensive patients with type II diabetes and impaired renal function

Abstract

The aim of this study was to compare the effects of ramipril and nitrendipine chronic treatment on urinary albumin excretion (UAE) in hypertensive patients with type II non-insulin-dependent diabetes mellitus (NIDDM) and impaired renal function. A 2-year, prospective, randomised study was conducted on 51 men with a diastolic blood pressure (DBP) у95 and р105 mm Hg, stable NIDDM, serum creatinine between 1.6 and 3.0 mg/dl and persistent UAE Ͼ300 and Ͻ2000 mg/24 h. After a 3-month preliminary observation period, during which patients began a low-protein, low-sodium diet, and a subsequent 4-week run-in period on placebo, patients were randomly treated with ramipril 5 mg or nitrendipine 20 mg for 2 years. Both drugs similarly reduced BP without affecting glucose homeostasis. In the ramipril group

Kidney Function During and After Withdrawal of Long-Term Irbesartan Treatment in Patients With Type 2 Diabetes and Microalbuminuria

“…Antihypertensive medications have been withdrawn in several previous and recent trials in hypertensive diabetic patients, typically in a 1-month wash-out period or placebo run-in phase before the study to assess baseline values (43)(44)(45)(46). Similarly, IRMA-2 was preceded by a 4-week wash-out period of previous antihypertensive medication (5).…”

Hypertension and diabetes

“…They may be renoprotective even if they do not reduce proteinuria as well as seen with ACE inhibitors. 15 ACEIs: An ACEI should always be used for those with proteinuria. This likely should be expended to normotensive diabetics with microalbuminuria: over 4 years, nine of 23 such patients on placebo advanced to diabetic nephropathy, whereas only two of 21 given captopril advanced.…”

“…26 Long-acting formulations including verapamil, diltiazem, the dihydropyridines amlodipine and nitrendipine have been found to be similar to ACEIs. 15,27 However, more protection against myocardial infarction was noted among those diabetics initially given enalapril than those initially given nisoldipine. 28 Most patients will likely end up needing the combination of an ACEI and a CA to lower blood pressure to below 130/80 mm Hg and the combination may very well protect renal and cardiac function better than either drug alone.…”

Hypertension in patients with type-II diabetes: relation to urinary albumin excretion, endothelial function and inflammation

“…9,10 Consistent with Schram et al, 6 many studies illustrate the difficulties in lowering blood pressures down to target ranges in diabetics. [11][12][13][14] A common mediator for the development of both microalbuminuria and end-organ damage in hypertension and diabetes seems to be angiotensin II, the blockade of which apparently reduces microalbuminuria, as well as end-organ damage. The beneficial effect of blockade of the renin-angiotensinaldosterone system (RAAS) is therefore not only for blood pressure reduction but also for end-organ protection in patients with type-II diabetes.…”