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Greater Reduction of Proteinuria For…

Greater Reduction of Proteinuria For Type 2 Diabetes With Enalapril/Losartan Combination
Enalapril plus losartan showed a reduction of 51% in proteinuria.

Combination therapy with losartan and enalapril is more effective in reducing proteinuria than either treatment alone in patients with nephropathy secondary to type 2 diabetes, according to a team of researchers from Turkey. Investigators led by R. Cetinkaya, MD, Department of Nephrology, Ataturk University, School of Medicine, enrolled 22 patients with nephropathy due to type 2 diabetes in this study designed to verify the additive anti-proteinuric effects of enalapril plus losartan.

“The benefits of angiotensin-converting enzyme inhibitors and angiotensin II (ATII) receptor antagonist therapy of diabetic nephropathy are thought to be largely the result of attenuation of ATII effects on proteinuria,” report the researchers.

During the first 12 weeks of the random trial, half the patients received enalapril 10 mg/day monotherapy orally in the morning while the other half received losartan 50 mg/day monotherapy orally in the morning.

After 12 weeks, 5 patients treated with enalapril monotherapy and 5 patients treated with losartan monotherapy were assigned to continue with a combination of enalapril 10 mg/day plus losartan 50 mg/day for 12 weeks.

Researchers also doubled the initial dose of enalapril from 10 mg/day to 20 mg/day and of losartan from 50 mg/day to 100 mg/day in the remaining 12 patients, for 12 weeks.

Blood pressure and proteinuria were assessed at baseline and after 24 weeks of therapy. Adverse effects were recorded at regular intervals during the study.

Results showed that proteinuria decreased by 33% in patients treated by single dose enalapril or losartan monotherapy. The combination enalapril plus losartan was more effective with a reduction of 51% in proteinuria. Patients treated with double doses of enalapril or losartan had a 37% reduction in proteinuria.

The combination enalapril plus losartan was associated with a significant reduction in mean arterial blood pressure compared to enalapril or losartan administered alone.

“We have found that proteinuria reduction induced by combined therapy is maintained throughout short-term follow-up,” the investigators added. Int J Clin Pract 2004 May;58:5:432-5

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Diabetes Care 2004; 27: 1047-1053