THE BENEFICIAL EFFECT OF ANGIOTENSIN-CONVERTING ENZYME-INHIBITION WITH CAPTOPRIL ON DIABETIC NEPHROPATHY IN NORMOTENSIVE IDDM PATIENTS WITHMICROALBUMINURIA

Citation
Lmb. Laffel et al., THE BENEFICIAL EFFECT OF ANGIOTENSIN-CONVERTING ENZYME-INHIBITION WITH CAPTOPRIL ON DIABETIC NEPHROPATHY IN NORMOTENSIVE IDDM PATIENTS WITHMICROALBUMINURIA, The American journal of medicine, 99(5), 1995, pp. 497-504
Citations number
40
Categorie Soggetti
Medicine, General & Internal
ISSN journal
00029343
Volume
99
Issue
5
Year of publication
1995
Pages
497 - 504
Database
ISI
SICI code
0002-9343(1995)99:5<497:TBEOAE>2.0.ZU;2-G
Abstract
PURPOSE: To determine whether angiotens-inconverting enzyme (ACE) inhi bition with captopril reduces the progression of microalbuminuria to o vert proteinuria in normotensive patients with insulin-dependent diabe tes mellitus (IDDM). PATIENTS AND METHODS: This study was a prospectiv e randomized, double-blind, placebo-controlled trial involving 26 cent ers in the United States and Canada. One hundred forty-three subjects, 14 to 57 years of age, with IDDM for 4 to 33 years, blood pressure <1 40/90 mm Hg in the absence of antihypertensive therapy, and persistent albumin excretion 20 to 200 mu g/min were randomized to double-blind treatment with captopril 50 mg or placebo BID. Albumin excretion rate (AER), blood pressure, and glycohemoglobin were determined every 3 mon ths, and creatinine clearance (CrCl) and urea excretion were measured every 6 months.RESULTS: Within 24 months, 6.0% (4/67) of captopril-tre ated subjects and 18.6% (13/70) of placebo-treated subjects progressed to clinical proteinuria, defined as AER >200 pg/min and at least 30% above baseline (risk reduction = 67.8%, P = 0.037). AER increased-at a n annual rate of 11.8% (95% confidence interval [CI] -3.3% to 29.1%) i n the placebo group, while it declined by 17.9% (CI -29.6% to -4.3%) i n the captopril group (P = 0.004). CrCl decreased by 4.9 mL/min per 1. 73 m(2) per year in the placebo group, while it remained stable in the captopril group (0.9 mL/min per 1.73 m(2) per year, P = 0.039 between groups). Ten subjects required treatment for hypertension; 8 in the p lacebo group and 2 in the captopril group.