Delapril versus manidipine in hypertensive therapy to halt the type-2-diabetes-mellitus-associated nephropathy

Thirty-nine hypertensive patients with type 2 diabetes mellitus were follow ed under long-term treatment (mean, 20.7 months) with manidipine hydrochlor ide, a Ca antagonist, or delapril hydrochloride, an ACE inhibitor, at nine institutions. Both the treatments showed similar antihypertensive effects, although slight but significantly larger decreases were observed in systoli c and mean blood pressures at months 12 and 24 in the patients treated with manidipine (P < 0.02). The urinary albumin excretion index (AEI) tended to increase throughout the study in both treatment groups, but no significant difference in AEI was observed between the two treatment groups at any tim e point. Overt albuminuria developed in four patients on manidipine but did not appear in any of the patients on derapril. The risk of progression to overt albuminuria was significantly different between manidipine and delapr il groups (P = 0.011). No increase in serum creatinine (Cr) was observed wi th delapril. The average excretion indexes of tubular markers such as beta( 2)-microglobulin, alpha(1)-microglobulin, and NAG tended to be higher in th e patients on manidipine than in those on delapril. Taken in sum, these fin dings suggest that the ACE inhibitor delapril is more beneficial than the C a antagonist manidipine in the treatment of diabetic renal diseases via mec hanisms other than the blood pressure regulation, partly through their diff erent effects on tubular function. In conclusion delapril was significantly more effective than manidipine in inhibiting progression to overt albuminu ria in hypertensive type 2 diabetes mellitus patients. (C) 2000 Elsevier Sc ience Ireland Ltd. All rights reserved.