COMPARATIVE EFFECTS OF DIFFERENT ANTIHYPERTENSIVE TREATMENTS ON PROGRESSION OF DIABETIC RENAL-DISEASE

Background: Given the same level of arterial pressure control, studies in diabetic animal models have demonstrated certain classes of antihy pertensive medication to confer better overall preservation of renal h istologic features and function as well as reduced albuminuria when co mpared with other agents. The present study was designed to assess whe ther any differences exist among antihypertensive agents with regard t o progression of diabetic renal disease and albuminuria in human subje cts. Methods: The study was a randomized, prospective, parallel group design that evaluated the effects of a converting enzyme inhibitor (li sinopril; group 1), a calcium antagonist (diltiazem hydrochloride; gro up 2), and a combination of a loop diuretic and a beta-blocker (furose mide and atenolol; group 3) in 30 subjects. All subjects received a lo w-salt, low-protein diet. Metabolic (blood glucose, cholesterol profil es, and urine urea nitrogen and sodium levels) as well as renal hemody namic (renal blood flow and glomerular filtration rate) profiles and a rterial pressure measurements were performed at various intervals duri ng an 18-month period. Results: Both groups 1 and 2 had significantly slower rates of decline in glomerular filtration rate compared with gr oup 3. No significant differences were observed in renal hemodynamics between groups 1 and 2 at 18 months. Group 3 had the worst metabolic, lipid, and side-effect profile of any group. Reductions in albuminuria were not different between groups 1 and 2, but both were significantl y reduced compared with group 3. Conclusions: Given a similar level of arterial pressure control, both lisinopril and diltiazem slow progres sion of diabetic renal disease and reduce albuminuria to a greater ext ent than does the combination of a loop diuretic and beta-adrenorecept or antagonist. These drugs were also better tolerated and produced no adverse metabolic effects.