Randomised controlled trial of long term efficacy of captopril on preservation of kidney function in normotensive patients with insulin dependent diabetes and microalbuminuria

Mathiesen, Elisabeth Reinhardt; Hommel, E.; Hansen, Henrik Post; Smidt, Ulla M; Parving, Hans‐Henrik

doi:10.1136/bmj.319.7201.24

Cited by 173 publications

(95 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In our 11 year observational follow-up study evaluating the renoprotective effect of implementing RAAS-blocking treatment in type 1 diabetic patients with microalbuminuria, we found an overall decrease in UAER during follow-up and a reduction in progression to overt DN similar to values found in previous randomised, double-blind RAAS-blockade intervention trials of shorter duration [11][12][13][14][15]. In the present study, long-term RAAS-blocking treatment was prescribed in 85% of type 1 diabetic patients with microalbuminuria and low-dose aspirin and statins in approximately 60% (at the end of follow-up).…”

Section: Discussionsupporting

confidence: 85%

“…In type 1 diabetic patients with microalbuminuria not receiving antihypertensive treatment, an increase in urinary AER (UAER) of 6-14%/year and a risk of developing diabetic nephropathy (DN) of 3-30%/year have previously been reported [1][2][3][4][5][6][7][8][9][10]. Several clinical trials of short or medium duration have shown a beneficial effect of blocking the renin-angiotensin-aldosterone system (RAAS) with an ACE inhibitor (ACEI) on progression of albuminuria, the development of diabetic nephropathy and the decline in kidney function [6,7,[9][10][11][12][13][14][15]. Angiotensin II receptor blockers (ARBs) have been shown to have a similar effect in type 2 diabetic patients with microalbuminuria [16].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Long-term prevention of diabetic nephropathy: an audit

et al. 2008

Self Cite

View full text Add to dashboard Cite

Aims/hypothesis In type 1 diabetic patients with microalbuminuria not receiving antihypertensive treatment, an increase in urinary AER (UAER) of 6-14%/year and a risk of developing diabetic nephropathy (DN) of 3-30%/year have been reported. We audited the long-term effect of blocking the renin-angiotensin-aldosterone system (RAAS) with an ACE inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in microalbuminuric type 1 diabetic patients on progression of microalbuminuria and development of DN. Methods All patients with type 1 diabetes and persistent microalbuminuria (30-300 mg/24 h) were identified (n=227) in 1995 at Steno Diabetes Center and followed for 11 years. Development of DN was defined as a UAER of >300 mg/24 h in two of three consecutive urine samples. Results Age and duration of diabetes at baseline (mean±SD) were 46±15 and 28±13 years, respectively. During followup 14 patients emigrated and 58 (26%) died. Over the same period 79% were treated with an ACEI or ARB. There was a mean decline in UAER of 4%/year. Sixty-five patients (29%) progressed to overt DN, corresponding to 3.1%/year. However, 29 of them regressed to normo-or microalbuminuria on intensified antihypertensive treatment. Glycaemic control and blood pressure remained nearly unchanged. Conclusions/interpretation In our outpatient clinic, the implementation of RAAS-blocking treatment in type 1 diabetic patients with microalbuminuria successfully reduced longterm progression to overt DN to a rate similar to those previously reported in randomised, double-blind intervention trials of shorter duration using RAAS blockade.

show abstract

Section: Discussionsupporting

confidence: 85%

mentioning

confidence: 99%

Long-term prevention of diabetic nephropathy: an audit

et al. 2008

Self Cite

View full text Add to dashboard Cite

show abstract

“…In diabetic patients with microalbuminuria treatment with ACE-inhibitors (ACE-i) is known to reduce albuminuria, impede progression to overt nephropathy [25,26,27], and preserve GFR [28].The importance of strict blood pressure control in diabetic patients is well established [29,30] and often combination therapy is necessary to obtain normotension [31]. Thus, the combination of ACE-i and β-blockers in patients with a high risk of cardiovascular disease seems well motivated.…”

mentioning

confidence: 99%

Effects on heart rate variability of metoprolol supplementary to ongoing ACE-inhibitor treatment in Type I diabetic patients with abnormal albuminuria

et al. 2002

View full text Add to dashboard Cite

difference in heart rate between inspiration and expiration; LF, square root of power of the low frequency oscillation; LF power, power of the low frequency oscillation; Mean RR, mean of all normal RR intervals; Mean RR D-N, difference between awake and sleep time in mean RR; RSA, respiratory sinus arrhythmia; SDANN, standard deviation of the mean RR in all 5 min segments in a 24 h period; SDNN, standard deviation of all normal RR intervals; SDNN index, mean of SD's calculated on 5 min of RR intervals during a 24 h period; SE, standard error; sNN6%, number of successive RR interval differences > 6%, standardized to 24 h; sNN50, number of successive RR interval differences > 50 ms, standardized to 24 h; UAE, urine albumin excretion. AbstractAims/hypothesis. Diabetic nephropathy is associated with a high risk of cardiac mortality including sudden death. This is presumably related to an imbalance between sympathetic and parasympathetic tone resulting in a decreased heart rate variability (HRV). In nondiabetic patients a decreased HRV is known to be a strong predictor of cardiovascular death. Studies in non-diabetic patients have shown that β-blockers improve HRV parameters known to reflect parasympathetic function. The aim of our study was to investigate effects of additional β-blocker treatment on: cardiac autonomic function, blood pressure, and urine albumin excretion in ACE-inhibitor treated Type I (insulin-dependent) diabetes mellitus patients with abnormal albuminuria. Methods. We studied the effects of 6 weeks treatment with metoprolol (100 mg once daily, zero order kinetics formulation) in 20 patients participating in a randomised, placebo controlled, double blind, crossover trial. Patients were simultaneously monitored under ambulatory conditions with 24-h Holter-monitoring, Corresponding author: Dr. E. Ebbehøj, Medical Department M (Diabetes and Endocrinology), Aarhus Kommunehospitalet, DK-8000 Aarhus Denmark, E-mail: e.ebbehoj@dadlnet.dk Abbreviations: AMBP, Ambulatory blood pressure; CCVHF, coefficient of component variance for HF; CCVLF, coefficient of component variance for LF; HF, square root of power of the high frequency oscillation; HF power, power of the high frequency oscillation; HRV, heart rate variability; HRV index, geometric index of total variability in a 24 h period; I-E diff, Diabetologia (2002) 45:965-975 DOI 10.1007 Effects on heart rate variability of metoprolol supplementary to ongoing ACE-inhibitor treatment in Type I diabetic patients with abnormal albuminuria 24-h ambulatory blood pressure recording, and 24-h fractionated urine collections. Heart rate variability was assessed by four different methods; ambulatory HRV analysis was carried out by spectral and time domain analysis, and on days of investigation short-term spectral analysis and bed-side tests were carried out. Results. Metoprolol treatment improved in vagal tone assessed by short-term spectral analysis. The 24-h ambulatory HRV analysis showed improvement in some parameters reflecting vagal function. A minor decrease in...

show abstract

“…Based on this hypothesis of hyperfiltration, the effect of ACEI's in retarding the progression of renal disease independent of its antihypertensive effect has been the subject of many studies [9][10][11][12][13][14][15][16]. The use of ACEI's is recommended in all type 1 and type 2 diabetic patients with microalbuminuria.…”

Section: Definition Of Chronic Kidney Diseasementioning

confidence: 99%