Microalbuminuria Reduction With Valsartan in Patients With Type 2 Diabetes Mellitus

Abstract

For the same level of attained BP and the same degree of BP reduction, valsartan lowered UAER more effectively than amlodipine in patients with type 2 diabetes and microalbuminuria, including the subgroup with baseline normotension. This indicates a BP-independent antiproteinuric effect of valsartan.

Current status of angiotensin receptor blockers for the treatment of cardiovascular diseases: focus on telmisartan

“…Valsartan lowered the albumin excretion rate by 44 vs 8% for amlodipine, which was independent of blood pressure reduction. 68 Similar results have been reported in two other large multicentre, doubleblind clinical outcome studies. In one, 1715 type II diabetic hypertensive patients were randomized to irbesartan 300 mg once daily, (n ¼ 579) amlodipine 10 mg once daily (n ¼ 567) or placebo (n ¼ 569) and followed for 2.6 years.…”

“…[63][64][65][66][67][68][69][70][71] The protein leakage in diabetic hypertensive patients has been attributed to endothelial dysfunction, which is present in both diabetes and hypertension. 72 Microalbuminuria in type II diabetic, 73 or nondiabetic hypertensive 74 patients has been associated, besides renal failure, with cardiovascular complications.…”

Rationale and design of a study comparing two fixed-dose combination regimens to reduce albuminuria in patients with type II diabetes and hypertension

“…17 Pharmacologic inhibition of the RAA system has been shown to control BP, reduce albuminuria, and protect against progressive renal damage. [6][7][8][9][10][11][12][13][14][15] However, the target-organ protection is attenuated when BP is not adequately controlled. 6 ACE inhibitors used as monotherapy do not adequately control hypertension in many cases, and three or more agents are usually required.…”

“…Reduction in proteinuria that is partially independent of BP reduction has been demonstrated in MARVAL (MicroAlbuminuria Reduction with VALsartan). 11 The optimal doses employed for renal protection may be greater than those used for lowering BP. 12 However, there are scant data with ACE inhibitors from outcome trials to evaluate their effects with other classes of antihypertensive agents on hard end points such as ESRD.…”

Conservative Management of Chronic Renal Failure

“…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.…”