ACE Inhibitors and ARBs Have Same Impact on Proteinuria and BP Reduction in Patients With Diabetic Nephropathy
Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) either alone or in combination appear to have comparable impact in reducing proteinuria and blood pressure in patients with diabetic nephropathy.
For this investigation, Dr. Iqbal and his team enrolled 90 patients with diabetic nephropathy with proteinuria 0.5 g/day or greater, and randomized them to receive either the ACEI enalapril up to 40 mg/day, the ARB losartan up to 100 mg/day, or a combination of the two medications up to 20 mg + 100 mg/day.
Investigators identified the primary end point of the study as reduction in blood pressure to 110/70 mm Hg.
They evaluated patients at baseline, after 4 weeks of treatment, and after attaining a maximum allocated/tolerated dose (11 ± 5 weeks).
At recruitment, the ACE group had serum creatinine levels of -1.6, the ARB group had levels of 1.5 and those in the combination therapy group had levels of 1.6 mg/dL. In terms of urine total protein (UTP), the ACE group had 3 g/day (1–11), the ARB group had 2 g/day (1–9), and the combination group had 3 g/day (1–11).
Systolic blood pressure was 151 mm Hg in the ACE group, 145 mm Hg in the ARB group and 156 mm Hg in the combination group. Diastolic blood pressure readings in the ACE, ARB and Combination groups were 87, 85 and 90 mm Hg, respectively.
During all follow-up visits, investigators found significant UTP and BP reductions in all treatment groups. When they conducted inter-drug group analyses after 4 weeks (ACE versus ARB versus combination) they found that UTP was 2.1, 1.6 and 2.6 g/day (P = NS), systolic blood pressure was 137, 138 and 148 and diastolic blood pressure was 81, 81 and 85 mm Hg.
After 11 weeks (and ± 5 weeks) of treatment, investigators reported that UTP was 1.9 g/day (0.21–9.1) in the ACE group, 1.5 g/day(0.42–6) in the ARB group and 2.3 g/day (0.20–10) in the combination group (P = NS), systolic blood pressure was 135, 134 and 142, and diastolic BP was 81, 79 and 82 mm Hg (P = NS), respectively.
They concluded that angiotensin converting enzyme inhibitors and angiotensin receptor blockers alone or in combination are similarly effective in reducing proteinuria and blood pressure in patients with diabetic nephropathy.
Presented on June 28th at the World Congress of Nephrology (WCN). [Presentation title: Effect of Renin Angiotensin System Inhibitors and Blockers on Proteinuria and Blood Pressure Reduction in Patients With Diabetic Nephropathy. Abstract M-PO20059] Masud Iqbal, MD, Associate Professor, Nephrology Department, North East Medical College, Bangladesh.