Abstract |
Angiotensin converting enzyme (ACE) inhibition has shown promising results in diabetic nephropathy, but long-term results on survival are not available. In a cohort of patients receiving antihypertensive treatment predominantly consisting of beta blockers in combination with diuretics, support for an improved survival has been presented. Addition of ACE inhibition to such a combination treatment may be favorable both due to the suggested renoprotective effects of ACE inhibitors and because diuretics activate the renin-angiotensin system. In 10 insulin-dependent diabetic patients with early diabetic nephropathy [urinary albumin excretion rate (UAE) less than 100o micrograms/min], who were receiving continuous therapy with metoprolol and bendroflumethiazide, a double-blind crossover study with four months addition of ramipril 5 mg ( Ramace) and placebo was conducted. UAE (radioimmunoassay) and fractional albumin excretion were significantly reduced after the four months of ramipril administration [UAE: 114.1 x/divided by 1.3 (geometric mean x/divided by confidence factor] versus 174.6 x/divided by 1.2 micrograms/min, 2P less than 0.005). Renal plasma flow (clearance of 131I-hippuran) tended to increase [497 +/- 25 (mean +/- SE) vs. 464 +/- 28 ml/min/1.73 m2, 2P = 0.08], while GFR (125I-iothalamate) stayed unchanged (121 +/- 8 vs. 120 +/- 9 ml/min/1.73 m2). Mean arterial pressure during clearance studies fell moderately (95 +/- 3 vs. 101 +/- 1 mm Hg, 2P less than 0.05) and renal resistance was decreased (2P less than 0.03). ACE activity was suppressed in all patients. Twenty-four-hour ambulatory blood pressure measurements were not significantly different after the two periods (daytime averages: 91 +/- 2 vs. 93 +/- 2, nighttime 80 +/- 2 vs. 84 +/- 3 mm Hg).(ABSTRACT TRUNCATED AT 250 WORDS)
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Authors | M M Pedersen, K W Hansen, A Schmitz, K Sørensen, C K Christensen, C E Mogensen |
Journal | Kidney international
(Kidney Int)
Vol. 41
Issue 4
Pg. 883-90
(Apr 1992)
ISSN: 0085-2538 [Print] United States |
PMID | 1355149
(Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Adrenergic beta-Antagonists
- Angiotensin-Converting Enzyme Inhibitors
- Diuretics
- Hormones
- Peptidyl-Dipeptidase A
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Topics |
- Adrenergic beta-Antagonists
(therapeutic use)
- Adult
- Angiotensin-Converting Enzyme Inhibitors
(therapeutic use)
- Blood Pressure
- Diabetic Nephropathies
(blood, drug therapy, physiopathology)
- Diuretics
(therapeutic use)
- Drug Therapy, Combination
- Echocardiography
- Female
- Hormones
(blood)
- Humans
- Kidney
(physiopathology)
- Male
- Middle Aged
- Peptidyl-Dipeptidase A
(blood)
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