Captopril or conventional therapy in hypertensive type II diabetics. Three-year analysis.

Abstract

The effects of long-term treatment with captopril and conventional therapy on albuminuria and metabolic parameters were compared in 74 hypertensive type II diabetics with normal serum creatinine. Patients were treated double-blind with either captopril monotherapy or combined with hydrochlorothiazide or therapy with metoprolol, hydrochlorothiazide, or both for 36 months. The treatment was titrated to achieve goal diastolic blood pressure of £85 mm Hg. The reductions in blood pressures during treatment were similar in patients with (n=21) and without (n=53) microalbuminuria treated with either captopril or conventional therapy. No significant changes in albuminuria occurred in normoalbuminuric patients with either therapy. Although albuminuria fell in nearly all patients with microalbuminuria treated with captopril, it rose in eight of 12 patients on conventional therapy, with macroalbuminuria developing in two of them. Renal function was preserved by both types of treatment in both patient groups. Long-term treatment with either conventional therapy or captopril did not alter metabolic variables. We conclude that captopril alone or in combination decreases albuminuria and prevents the development of macroalbuminuria in hypertensive type II diabetics with persistent microalbuminuria. The renoprotective effect of this agent, however, remains to be demonstrated with longer term data on renal function. Aggressive antihypertensive treatment with either captopril or conventional therapy appears to be effective in preventing the onset of microalbuminuria in most normoalbuminuric patients. In contrast, with previous short-term studies, the use of converting enzyme inhibitors or conventional therapy did not cause adverse metabolic effects. (Hypertension 1993^1:786-794) KEY WORDS • diabetes mellitus, non-insulin-dependent • captopril • antihypertensive agents • albuminuria R ecent cross-sectional studies have revealed a prevalence of microalbuminuria between 27% and 40% in patients with non-insulin-dependent diabetes mellitus (NIDDM) or type II diabetes attending diabetic clinics.

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“…Antihypertensive medications have been withdrawn in several previous and recent trials in hypertensive diabetic patients, typically in a 1-month wash-out period or placebo run-in phase before the study to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).…”

Cost-Effectiveness of Early Irbesartan Treatment Versus Control (Standard Antihypertensive Medications Excluding ACE Inhibitors, Other Angiotensin-2 Receptor Antagonists, and Dihydropyridine Calcium Channel Blockers) or Late Irbesartan Treatment in Patients With Type 2 Diabetes, Hypertension, and Renal Disease

“…The placebo arm of the IRMA-2 and IDNT studies included commonly used antihypertensive treatment like diuretics, ␤-blockers, calcium channel blockers (except dihydropyridines), and central ␣-antagonists to achieve the target blood pressure of Ͻ135/85 mmHg (4,5). The evidence supporting a specific renoprotective effect of ACE inhibitors, i.e., a beneficial effect of ACE inhibitors on kidney function beyond the hypotensive effect in hypertensive patients with type 2 diabetes and microalbuminuria, is conflicting in the nine studies published to date (15)(16)(17)(18)(19)(20)(21)(22). The relatively long-term U.K.…”

Differential Effects of β-Blockers on Albuminuria in Patients With Type 2 Diabetes

“…Studies in diabetic and nondiabetic nephropathy with short-or long-acting ␤-blockers fail to show a substantive reduction in microalbuminuria when compared with angiotensin-converting enzyme (ACE) inhibition. [13][14][15] However, to date, ␤-blockers have not been examined with regard to their effects on albuminuria in the presence of agents already known to affect blood pressure and albuminuria (ie, ACE inhibitors or angiotensin receptor blockers [ARBs]). …”