EFFECTS OF AN ANGIOTENSIN-CONVERTING ENZY ME-INHIBITOR ON URINARY ALBUMIN EXCRETION IN NON-INSULIN-DEPENDENT DIABETIC-PATIENTS

Background: Microalbuminuria in diabetic patients is diagnostic of ear ly renal involvement and angiotensin converting enzyme inhibitors redu ce albumin excretion in these subjects. Aim: To assess the effects of an angiotensin converting enzyme inhibitor on urinary albumin excretio n in non insulin dependent diabetic patients. patients and methods: Di abetic patients with normal blood pressure were randomly assigned to r eceive enalapril 10 mg/day or placebo and followed during 18 months. T hose with high blood pressure were randomly assigned to received enala pril or acebutolol in doses necessary to normalize blood pressure and followed during 12 months. Every three months, urinary albumin excreti on was measured in a four hour urine sample by radioimmunoassay. Resul ts: One hundred fifty two patients were recruited for the study and 46 were lost from follow up. In 17 subjects with normal blood pressure i nitial urinary albumin excretion below cutoff values (30 mg/24 h) and treated with enalapril, this parameter did not change; in 20 treated w ith placebo, it increased from 5.8 +/- 6.1 to 18.2 +/- 7.5 mg/24 h. In 11 patients with normal pressure and increased initial urinary albumi n, this parameter did not change with enalapril and increased in 10 wi th placebo from 87.3 +/- 75.1 to 253.6 +/- 61.1 mg/24 h. In hypertensi ve patients with normal urinary albumin excretion , no changes in this parameter were observed in those treated with acebutolol (n=10) or en alapril (n=14). In hypertensives with high urinary albumin excretion, it decreased from 119.2 +/- 8.5 to 40.0 +/- 4.7 mg/24 h with enalapril treatment (n=12), and no change was observed in those treated with ac ebutolol (n=11). Conclusions: Enalapril decreases urinary albumin excr etion in non insulin dependent diabetic patients.