Effect of enalapril and losartan on proteinuria in type 2 diabetic nephropathy patients

Abstract

A prospective, open label, parallel group and randomized study was conducted to see the effect of enalapril and losartan on proteinuria in type 2 diabetic nephropathy patients. 18 patients (proteinuria ≥ 0.5 gm/day and serum creatinine ≤3 mg/dL) were selected and then randomly grouped to receive enalapril (5-40 mg/day, n=10) and losartan (25-200 mg/day, n=8) in increasing dose for 16 weeks. No statistically significant alteration in the urinary total protein, protein creatinine ratio, serum creatinine, estimated glomerular filtration rate, serum potassium and blood pressure was observed in any group. After attaining maximum dose (40 mg and 200 mg respectively), enalapril group showed significant (p<0.04) reduction of protein creatinine ratio in comparison to losartan group. It may be concluded that 40 mg enalapril or 200 mg losartan are not sufficient to reduce proteinuria and blood pressure significantly in type 2 proteinuric diabetics with renal dysfunction although both drugs were well tolerated at high doses.

Enalapril versus losartan for adults with chronic kidney disease: A systematic review and meta‐analysis

“…A total of 19 studies were excluded for the following reasons: the patients did not meet our criteria ( n = 14); the drug comparison did not meet our criteria ( n = 1); the article was a letter to the editor ( n = 2); the article was just a study protocol ( n = 1); and the study was a duplicate ( n = 1). A total of 17 studies (14 parallel‐group trials and three cross‐over trials) met our predefined criteria for inclusion. Data of cross‐over RCT were not extractable for patients after the first period of treatment.…”

“…The cross‐over trials were of short duration (4–8 weeks), and the parallel‐design trials were of longer duration (8 weeks to 6 years) . Eleven studies included only patients with hypertension (BP >140/90 mmHg), and three studies included patients with BP values of less than 150/95 mmHg . Three studies included patients receiving dialysis: ambulatory PD was used in a single study, and the others used HD .…”

“…Three studies included patients receiving dialysis: ambulatory PD was used in a single study, and the others used HD . Seven studies enrolled patients with diabetic nephropathy, three studies enrolled patients with immunoglobulin A nephropathy, and three studies included patients with primary glomerulonephritis . A single study included a different etiology of CKD from all the others; three others failed to report the etiology .…”

Arterial hypertension treatment with a calcium channel blocker and an ACE inhibitor. Benefits of combination therapy

“…В исследовании Hoque et al выраженности протеинурии у пациен-тов с сахарным диабетом 2 типа показано, что эналаприл достоверно более эффективно снижал соотношение креатинин/протеин мочи, нежели лозартан. Такие данные получены при приёме максимальных доз препаратов (40 мг эналаприла в сутки или 200 мг лозартана) после 16-недельного подбора терапии на фоне нормализации АД [8].…”

Enalapril: new possibilities

“…эналаприла или 200 мг/сут. лозартана) после 16-недельного подбора терапии, на фоне нормализации АД [14]. Сообщают о положительном влиянии эналаприла на течение диабетической ретинопатии у пациентов с СД 1 типа (СД-1).…”