Preventing Microalbuminuria in Type 2 Diabetes

Abstract

In subjects with type 2 diabetes and hypertension but with normoalbuminuria, the use of trandolapril plus verapamil and trandolapril alone decreased the incidence of microalbuminuria to a similar extent. The effect of verapamil alone was similar to that of placebo.

The clinical significance of hyperfiltration in diabetes

“…In normoalbuminuric, normotensive patients with type 1 diabetes, RAS inhibition has not been shown to prevent progression from normo-to microalbuminuria [67]. By contrast, in hypertensive patients with type 2 diabetes, progression from normoto microalbuminuria has been prevented by RAS inhibition using trandolapril, but not by similar blood pressure reduction with verapamil [68].…”

New concepts in blood pressure-lowering management in diabetic patients: the case for early ACE inhibitor combination therapy with diuretics

“…21 The BErgamo NEphrologic DIabetes Complications Trial (BENEDICT) was recently published. 22 Indeed, it is important to distinguish between normoalbuminuria and microalbuminuria and renal insufficiency as confirmed in the study by Adler et al 23 from the United Kingdom Prospective Diabetes Study (UKPDS). Clearly, patients with normoalbuminuria have the best prognosis, and there is strong evidence to show that preventing progression is associated with a much better prognosis, which was also documented in the recent paper by Gaede and co-workers from the Steno Diabetes Center.…”

“…24,25 Thus, the most recent and comprehensive study regarding primary prevention, meaning that microalbuminuria can be prevented in type II diabetes, comes from the BENEDICT study group in Bergamo. 22 This is the largest study so far conducted, and, very interestingly, this study also compares an ACE inhibitor with a calcium channel blocker, verapamil (a so-called nondihydropyridine). This was a large study in Northern Italy, comprising 1204 patients randomly assigned to 3 years of treatment with trandolapril alone, trandolapril þ verapamil, verapamil alone, and placebo.…”

“…This was a large study in Northern Italy, comprising 1204 patients randomly assigned to 3 years of treatment with trandolapril alone, trandolapril þ verapamil, verapamil alone, and placebo. 22 Interestingly, hypertension was defined as low as a blood pressure X130/85 mmHg or as the need for antihypertensive treatment to attain a systolic or diastolic blood pressure under these levels. The primary end point was development of persistent microalbuminuria with an overnight AER higher than 20 mg/min on two consecutive occasions.…”

ADVANCE: action in diabetes and vascular disease

“…The benefits of ACE inhibitor therapy in patients with diabetes and early manifestations of nephropathy have also been confirmed in recent studies and analyses comparing ACE inhibitors with a variety of blood pressure-lowering drugs. [12][13][14] The potential benefits of lowering blood pressure in nonhypertensive patients with diabetes are less well documented.…”