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Aliskiren in combination with losartan reduces albuminuria independent of baseline blood pressure in patients with type 2 diabetes and nephropathy.

AbstractBACKGROUND AND OBJECTIVES:
Elevated BP contributes to development and progression of proteinuria and decline in renal function in patients with type 2 diabetes. Our post hoc analysis assessed the baseline BP influence on the antiproteinuric effect in the Aliskiren in the Evaluation of Proteinuria in Diabetes (AVOID) study.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:
In the AVOID study, 599 hypertensive type 2 diabetic patients with nephropathy received 6 months of aliskiren (150 mg force titrated to 300 mg daily after 3 months) or placebo added to losartan (100 mg) daily and optimal antihypertensive therapy. Changes in early morning urinary albumin:creatinine ratio and eGFR at week 24 were assessed by subgroups of baseline BP: Group A (prespecified target), <130/80 mmHg (n=159); Group B, <140/90 mmHg but ≥130/80 mmHg (n=189); and Group C (insufficient BP control), ≥140/90 mmHg (n=251).
RESULTS:
Mean baseline BP (mmHg) levels for Groups A, B, and C were 120/71, 133/78, and 145/81, respectively. BP during the trial was nearly identical to baseline levels in all groups. The antiproteinuric effects of aliskiren were consistent across subgroups of baseline BP (19 to 22% reduction versus placebo). In Group C, the decline in eGFR was significantly lower with aliskiren than with placebo (P=0.013).
CONCLUSIONS:
Aliskiren (300 mg) added to losartan (100 mg) plus optimal antihypertensive therapy provides antiproteinuric effects independent of BP in patients with type 2 diabetes and nephropathy. Renal function was better preserved with aliskiren in patients with insufficient BP control.
AuthorsFrederik Persson, Julia B Lewis, Edmund J Lewis, Peter Rossing, Norman K Hollenberg, Hans-Henrik Parving
JournalClinical journal of the American Society of Nephrology : CJASN (Clin J Am Soc Nephrol) Vol. 6 Issue 5 Pg. 1025-31 (May 2011) ISSN: 1555-905X [Electronic] United States
PMID21350110 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2011 by the American Society of Nephrology
Chemical References
  • Amides
  • Antihypertensive Agents
  • Fumarates
  • Placebos
  • aliskiren
  • Losartan
Topics
  • Aged
  • Albuminuria (drug therapy, physiopathology)
  • Amides (administration & dosage, adverse effects)
  • Antihypertensive Agents (administration & dosage, adverse effects)
  • Blood Pressure (drug effects, physiology)
  • Diabetes Mellitus, Type 2 (drug therapy, physiopathology)
  • Diabetic Nephropathies (drug therapy, physiopathology)
  • Drug Therapy, Combination
  • Female
  • Fumarates (administration & dosage, adverse effects)
  • Humans
  • Hypertension, Renal (drug therapy, physiopathology)
  • Losartan (administration & dosage, adverse effects)
  • Male
  • Middle Aged
  • Placebos
  • Treatment Outcome

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