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

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.