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ARB & ACE Combination Best in Diabetic Nephropathy

Combining angiotensin II receptor blockade with angiotensin-converting enzyme (ACE) inhibition improved albuminuria and lipid profile compared with either therapy alone in patients with diabetic nephropathy. That, according to the results of a study published in the April issue of the Journal of the American Society of Nephrology. ” Albuminuria and hypertension are predictors of poor renal and cardiovascular outcome in diabetic patients,” write Peter Jacobsen and colleagues from the University of Aarhus in Denmark. “A superior effect on blood pressure and a tendency toward a more pronounced drop in urinary albumin excretion of dual blockade of the renin-angiotensin system compared with single blockade has been reported in [type 2] patients with microalbuminuria.”

In this double-blind, crossover trial, 20 type 1 diabetic patients with diabetic nephropathy were randomized to eight weeks of treatment with placebo, 20 mg of benazepril once daily, 80 mg of valsartan once daily, or the combination of 20 mg of benazepril and 80 mg of valsartan. Eighteen patients completed the study.

Compared with placebo, benazepril and valsartan were equally effective in reducing albuminuria and blood pressure. Compared with either monotherapy, dual blockade reduced albuminuria by 43% (range, 29% – 54%) and reduced both systolic and diastolic blood pressure by 6 to 7 mm Hg. Dual blockade reversibly reduced glomerular filtration rate compared with monotherapy and placebo. All treatments were safe and well tolerated.

” Dual blockade of the renin-angiotensin system may offer additional renal and cardiovascular protection in [type 1] diabetic patients with diabetic nephropathy,” the authors write, while recommending additional studies. “Treatment with both ACE inhibitors and angiotensin II-receptor blockers may offer synergistic blockade of the renin-angiotensin system not obtainable with either drug alone.”

Novartis Healthcare A/S helped support this study. J Am Soc Nephrol. 2003;14:992-999

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