Long-term effects of amlodipine versus fosinopril on microalbuminuria in elderly hypertensive patients with type 2 diabetes mellitus

Objective: The aim of this study was to compare the effects on urinary albu min excretion (UAE) of amlodipine versus fosinopril in elderly hypertensive patients with type 2 diabetes mellitus. Methods: We studied 147 elderly (60 to 75 years) hypertensive patients (dia stolic blood pressure > 90 mm Hg) with concomitant, well-controlled type 2 diabetes mellitus. After a 4-week placebo period (at the beginning of which current antihypertensive agents were discontinued), they were randomly all ocated to receive amlodipine 5 to 10 mg once daily (n = 73) or fosinopril 1 0 to 20 mg once daily (n = 74) for 24 months. Nonresponders to monotherapy were discontinued after 8 weeks. At the end of the placebo period and after 3, 6, 12, 18, and 24 months of treatment, blood pressure (BP), glycosylate d hemoglobin A(1c), UAE, and creatinine clearance were determined. Results: Seventy-nine patients completed the 24-month study. Both amlodipin e and fosinopril similarly reduced BP without affecting glucose homeostasis . At 3 months, UAE was significantly reduced (P < 0.01) only in the fosinop ril-treated patients; however, at 12 and 24 months, it was significantly de creased with both drugs (fosinopril, P < 0.01; amlodipine, P < 0.05). Creat inine clearance was unaffected by fosinopril but was significantly increase d (P < 0.05) by amlodipine at 12 months. Conclusions: Based on these results, we concluded that longterm treatment w ith both amlodipine and fosinopril was effective in reducing UAE in elderly hypertensive patients with type 2 diabetes mellitus and microalbuminuria.