Effects of Lisinopril and Nifedipine on the Progression to Overt Albuminuria in IDDM Patients With Incipient Nephropathy and Normal Blood Pressure

Crepaldi, Gaetano; Carta, Q; Deferrari, Giacomo; Mangili, Ruggero; Navalesi, Renzo; Santeusanio, Fausto; A, Spalluto; Vanasia, Alessandro; Villa, Giuseppe; Nosadini, R.

doi:10.2337/diacare.21.1.104

Cited by 108 publications

(54 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In previous studies not using RAAS-blocking treatment, an annual increase in UAER of 5-70% in type 1 diabetic patients with microalbuminuria has been reported [4,5,[7][8][9][10]. In contrast, we found an overall decrease in UAER after the introduction of RAAS-blocking treatment.…”

Section: Discussioncontrasting

confidence: 52%

“…Subsequently, multiple trials have looked at progression rates from micro-to macroalbuminuria and reported progression rates ranging from 5.6 to 30%/year [5][6][7][8][9][10]. Intervention trials have demonstrated that ACEIs reduce the progression from micro-to macroalbuminuria and preserve GFR in type 1 diabetic patients [11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

“…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 2 more Smart Citations

Long-term prevention of diabetic nephropathy: an audit

et al. 2008

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: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Long-term prevention of diabetic nephropathy: an audit

et al. 2008

View full text Add to dashboard Cite

show abstract

“…65 The Italian Microalbuminuria Study Group in Type 1 diabetes suggested no significant difference in reduction in albumin excretion ratio after three years of therapy with nifedipine versus the ACE-I, lisinopril. 66 The numbers of patients in both studies were small.…”

Section: Type 1 Diabetes Mellitusmentioning

confidence: 99%

Review: Calcium channel blockade in combination with angiotensin-converting enzyme inhibition or angiotensin II (AT1-receptor) antagonism in hypertensive diabetics and patients with renal disease and hypertension

Swales

Williams

2002

J Renin Angiotensin Aldosterone Syst

View full text Add to dashboard Cite

Effective reduction in blood pressure (BP) improves survival and morbidity in hypertensive patients. Combination therapy with multiple antihypertensive agents is frequently required in clinical practice and therapeutic trials to achieve target BP. Patients at elevated cardiovascular risk achieve the greatest benefit from equivalent reduction in BP and also require more stringent BP control. In patients with hypertension and diabetes mellitus or renal disease, BP control is of primary importance and blockade of the renin-angiotensin system (RAS) should be the initial therapeutic intervention. Choice of combination therapy has been insufficiently studied in major clinical cardiovascular endpoint trials. Diuretic therapy remains the logical addition to RAS blockade. Despite previous debate, the available evidence suggests long-acting calcium-channel blockers are also a safe and very effective addition to improve BP control further. The choice of antihypertensive combination therapy should not override the fundamental necessity of lowering BP to target levels.

show abstract

“…The 58 patients participated in two randomised, placebo-controlled, double-blind studies. 65,66 In the subgroup of patients examined in Aarhus (n=22), we performed 24-hour AMBP and renal function tests (constant infusion technique, see below). In the 22 patients with Type 1 diabetes and low grade microalbuminuria (UAE 20-70 µg/minute) mentioned above, we examined the effects of two years treatment with either lisinopril (20 mg o.d.)…”

Section: Participantsmentioning

confidence: 99%