Outcome survey in unselected hypertensive patients with type 2 diabetes mellitus: effects of ACE inhibition

Although the benefit of angiotensin converting enzyme (ACE) inhibitors in d iabetic nephropathy is well documented in double-blind randomized, controll ed clinical trials, it is uncertain whether the benefit extends to unselect ed patients with diabetes mellitus and,arterial hypertension in general pra ctice. In 2504 unselected patients with type 2 diabetes mellitus (mean age 63 +/- 10 years) blood pressure, cardiovascular, renal, and metabolic param eters were assessed at baseline and during a treatment period of I year wit h the ACE inhibitor cilazapril by primary care physicians. The average dose of cilazapril was 2.5 mg/day. Outcome measures were blood pressure, serum creatinine, proteinuria (dip stick), HbA(1c) levels, evaluation of edema, a nd exertional dyspnea. In the study cohort, systolic blood pressure decreas ed by 24 +/- 17 mm Hg and diastolic blood pressure by 12 +/- 11 mm Hg. An i ncrease in serum creatinine (> 0.2 mg/dL) occurred more frequently in patie nts with than in those without renal involvement (19% v 7%; P < .05). Serum creatinine decreased more frequently in patients with renal involvement th an in those without (26% +/- 4% v 12% +/- 3.8%; P < .05). Overall renal fun ction in patients with diabetic nephropathy (n = 318) improved (2.1 +/- 1.6 mg/dL v 1.7 +/- 1.4 mg/dL; P < .05). The frequency of proteinuria was lowe r after 1 year than at baseline (62% +/- 9% v 82% +/- 8%; P < .05). Metabol ic control of diabetes mellitus improved in parallel (median HbA(1c) 8.0% v 7.0%; P < .01). Scores for edema formation and exertional dyspnea improved as well (P < .01). In this outcome survey of unselected patients with type 2 diabetes mellitus and arterial hypertension, the ACE inhibitor cilazapri l effectively lowered blood pressure, which was associated with an improvem ent in glucose metabolism, cardiac:function, and renal function. (C) 2001 A merican Journal of Hypertension, Ltd.