THE RENOPROTECTIVE EFFECT OF THE CONVERTI NG-ENZYME-INHIBITOR RAMIPRIL IN HYPERTENSIVE PATIENTS WITH INSULIN-TREATED TYPE-II DIABETES-MELLITUS - DEPENDENCE UPON BLOOD-PRESSURE AND GLYCEMIC CONTROL
E. Jungmann et al., THE RENOPROTECTIVE EFFECT OF THE CONVERTI NG-ENZYME-INHIBITOR RAMIPRIL IN HYPERTENSIVE PATIENTS WITH INSULIN-TREATED TYPE-II DIABETES-MELLITUS - DEPENDENCE UPON BLOOD-PRESSURE AND GLYCEMIC CONTROL, Nieren- und Hochdruckkrankheiten, 24(5), 1995, pp. 248-250
18 hypertensive insulin-treated patients received 5 mg/day ramipril or
ramipril + 30-10 mg/day furosemide for 6-12 months, Blood pressure fe
ll from 176/88 to 165/86 mmHg (p < 0.05 for systolic blood pressure).
In 13 patients (responders), urinary albumin excretion (UAE) was decre
ased. In the others (non-responders), UAE rose (p < 0.05 vs. responder
s). Accordingly urinary N-acetyl-beta-D-glucosaminidase, a tubular mar
ker enzyme, was decreased in responders but not in non-responders (p <
0.01). Non-responders differed from responders in age (62 vs. 68 year
s), known duration of diabetes (14 vs. 23 years), higher blood pressur
e before treatment (180/100 vs. 174/87 mmHg) and more pronounced insul
in resistance (hemoglobin(Alc), 8.4 vs. 7.1%, in contrast to insulin d
osage, 52 vs. 39 U/day, all p < 0.05). In non-responders, all calculat
ed values for mean arterial pressure exceeded 107 mmHg (responders, 31
%, p < 0.05). In type II diabetic patients, inadequate glycemic and bl
ood pressure control may not only precipitate the progression of diabe
tic nephropathy but may also impair the renoprotective efficacy of the
converting enzyme inhibitor ramipril.