EFFECT OF ENALAPRIL ON MICROALBUMINURIA AND LIPID PROFILE IN NORMOTENSIVE PATIENTS WITH TYPE-I DIABETES-MELLITUS

A longitudinal study for six months was conducted to demonstrate the i nfluence of enalapril therapy on microalbuminuria in a group of patien ts with IDDM without arterial hypertension. An evaluation was also con sidered of its possible activity on other biochemical parameters, part icularly plasma lipid levels. Thirty-four patients with IDDM were sele cted, with a mean age of 26.1 +/- 7.2 years and a mean clinical course of 11.8 +/- 5.6 years. Arterial blood pressure (ABP) was confirmed lo wer than 140/85 mmHg in all cases. Patients were administered 5 mg/day of enalapril and if a decrease in microalbuminuria higher than 25% wa s not achieved at the end of the first month of therapy, the dose was doubled (10 mg/day). No significant differences were found in ABP and in HbA1c throughout the study period. Albumin excretion in the initial period was 125.1 +/- 79.28 mg/24 h, at one month in the follow-up 47. 6 +/- 44.1 mg/24 h, at three months 23.8 +/- 18.1 mg/24 h, and at the end of the 6th month 15.33 +/- 6.9 mg/24 h, all differences being sign ificant. Renal function parameters and Na+ and K+ measurements remaine d unchanged for the follow-up period. No significant changes were dete cted for lipid and lipoprotein values for the length of the study. We conclude that therapy with enalapril in insulin-dependent diabetic pat ients without hypertension has an important effect on microalbuminuria during the first month of therapy; a stabilization in the normal rang e was reached in the third and sixth months of follow-up. No changes i n arterial blood pressure nor in renal function were observed. Plasma lipid values were in the normal range throughout the study. Therefore, treatment for microalbuminuria with the ACEI assayed was efficient, i n absence of arterial hypertension and irrespective of the metabolic c ontrol obtained. Future long-term studies are needed to evaluate the p ossible delay in the emergence of renal insufficiency.