Losartan titration versus diuretic combination in type 2 diabetic patients.

Abstract

METHODS:

We compared the effects of Losartan dose titration to 100 mg versus the addition of 12.5 mg of hydrochlorothiazide, in 90 type 2 diabetic patients with microalbuminuria and blood pressure > 130/85 mmHg, receiving losartan 50 mg as initial treatment during 4 weeks.

RESULTS:

With the first dose of losartan, systolic (SBP) and diastolic blood pressure (DBP) decreased from 154.5 (152.1-157.5) to 144.4 (141.3-147.5) mmHg (P < 0.001) and from 91.1 (89.4-92.8) to 84.6 (82.8-86.4) mmHg (P < 0.001), with 20 patients attaining the expected goal blood pressure (< 130/85 mmHg); albuminuria decreased from 109.8 (90.5-133.3) to 83.5 (63.6-109.5) mg per 24 h (P = 0.006). Patients not attaining the target blood pressure were randomly allocated to titration or to the combination arm. After an additional 4 weeks, patients titrated exhibited a fall in SBP and DBP from 157.1 (152.7-161.5) to 142.1 (136.4-147.8) mmHg (P < 0.001) and from 92.4 (89.5-95.3) to 83.6 (81.1-86.1) mmHg (P < 0.001); albuminuria decreased from 136.3 (97.8-189.9) to 99.7 (69.3-143.4) mg per 24 h (P = 0.002). In the combination arm, there were similar reductions in SBP and DBP from 155.3 (151.5-159.1) to 139.1 (132.1-146.1) mmHg (P < 0.001) and from 92.1 (89.3-94.9) to 80.9 (77.4-84.4) mmHg (P < 0.001); while albuminuria fell from 107.7 (82.2-141.0) to 64.2 (45.9-89.9) mg per 24 h (P = 0.001).

CONCLUSIONS:

Losartan 50 mg was effective in reducing blood pressure and albuminuria in type 2 diabetic patients. When the blood pressure target was not reached, the two strategies tested seem to contribute similarly to further reductions in blood pressure and albuminuria.

• Authors: Pedro Luis de Pablos-Velasco, Fernando Pazos Toral, Juan E Esmatjes, Francisco Fernandez-Vega, Martín Lopez Lopez de la Torre, Antonio Pozuelo, Luis M Ruilope
• Journal: Journal of hypertension (J Hypertens) Vol. 20 Issue 4 Pg. 715-9 (Apr 2002) ISSN: 0263-6352 [Print] England
• PMID: 11910308 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Antihypertensive Agents
• Diuretics
• Sodium Chloride Symporter Inhibitors
• Hydrochlorothiazide
• Losartan

Topics

• Aged
• Albuminuria (drug therapy, etiology)
• Antihypertensive Agents (administration & dosage)
• Blood Pressure (drug effects)
• Cardiovascular Diseases (prevention & control)
• Diabetes Mellitus, Type 2 (complications, drug therapy, physiopathology)
• Diabetic Angiopathies (prevention & control)
• Diabetic Nephropathies (prevention & control)
• Diuretics
• Drug Therapy, Combination
• Female
• Humans
• Hydrochlorothiazide (administration & dosage)
• Hypertension (drug therapy, etiology, physiopathology)
• Losartan (administration & dosage)
• Male
• Middle Aged
• Sodium Chloride Symporter Inhibitors (administration & dosage)