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J Med Assoc Thai. 2009 May;92(5):611-7.

Effects of dual blockade of renin-angiotensin system in type 2 diabetes mellitus patients with diabetic nephropathy.

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  • 1Department of Medicine, Rajavithi Hospital, Institute of Undergraduate Medical Education, Department of Medical Services in Affiliation with Rangsit University, Bangkok, Thailand. krairit@yahoo.com

Abstract

BACKGROUND:

Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB) have been shown to delay the progression to proteinuria and kidney failure in hypertensive type 2 diabetic patients with diabetic nephropathy. Further synergistic effect may be obtained by combined therapy with both ARB and ACE inhibitors.

OBJECTIVE:

To evaluate the effect of dual blockage of the renin-angiotensin system by adding maximal recommended dose of ARB with maximal recommended dose of ACE inhibitors in type 2 diabetic patients with diabetic nephropathy.

MATERIAL AND METHOD:

Type 2 diabetic patients with urine protein/creatinine (UPCr) > 0.5 gm/gm and hypertension who received maximal recommended dose of ACE inhibitors (Enalapril 40 mg/day) over three months were randomized to two groups. ARB group received adding maximal recommended dose of ARB (Telmisartan 80 mg/day) and control group received previous ACE inhibitors only for 24 weeks.

RESULTS:

Eighty patients were enrolled. ARB group led to significantly reduced UPCr from baseline at week 8, 12, and 24 (2.65 +/- 1.81, 2.24 +/- 1.85, 2.24 +/- 1.88 and 1.98 +/- 1.73 gm/gm respectively, p < 0.05) but UPCr in the control group was unchanged (1.97 +/- 1.56, 1.85 +/- 1.27, 1.97 +/- 1.11 and 1.96 +/- 1.42 gm/gm respectively, p > 0.05). ARB group induced an additional reduction in proteinuria of 29.25% (95% CI 9.68-48.82) compared with control group. By the end of the present study, glomerular filtration rate had fallen from 41.76 +/- 12.16 to 37.84 +/- 13.59 ml/min/1.73 m2 in ARB group and 50.89 +/- 29.43 to 49.41 +/- 29.85 ml/min/1.73 m2 in control group (p > 0.05). Serum potassium had changed from 4.51 +/- 0.48 to 4.58 +/- 0.13 mEq/L in ARB group and 4.60 +/- 0.58 to 4.40 +/- 0.13 mEq/L in the control group (p > 0.05). No other serious adverse effects were reported during treatment.

CONCLUSION:

Adding maximal recommended dose of ARB with maximal recommended dose of ACE inhibitors in type 2 diabetic patients can reduce proteinuria more than ACE inhibitors alone. This treatment is safe and well tolerated.

PMID:
19459520
[PubMed - indexed for MEDLINE]
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