EFFECTS OF LONG-TERM ENALAPRIL TREATMENT ON PERSISTENT MICROALBUMINURIA IN NORMOTENSIVE TYPE-2 DIABETIC-PATIENTS - RESULTS OF A 4-YEAR, PROSPECTIVE, RANDOMIZED STUDY

The beneficial effect of long-term treatment with an angiotensin-conve rting enzyme (ACE) inhibitor on urinary microalbumin excretion (UAE) a nd renal function was investigated in a 4 year, randomized prospective study in normotensive patients with non-insulin-dependent (Type 2) di abetes mellitus. Sixty-two normotensive patients with Type 2 diabetes mellitus and microalbuminuria but normal renal function were randomize d to receive either enalapril 5 mg day(-1) or no treatment. In the ena lapril-treated patients, UAE was reduced from 115.4 +/- 80.1 to 95.6 /- 61.7 mg 24 h(-1) after 12 months (p<0.05) and to 75.3 +/- 44.8 mg 2 4 h(-1) after 48 months (p<0.001). In the untreated group, UAE increas ed slowly from 93.9 +/- 69.9 to 150.0 +/- 144.5 mg 24 h(-1) after 48 m onths. No changes in creatinine clearance, blood pressure or HbA(1C) w ere seen in either group during the 4-year period. In normotensive Typ e 2 diabetic patients with early stage of diabetic nephropathy, the AC E inhibitor enalapril may have a beneficial effect by decreasing micro albuminuria. This effect is long-lasting and probably independent of t he antihypertensive action of the drug.