Losartan Versus HCTZ in Type 2 Diabetic Patients

Losartan 50 mg was effective in reducing blood pressure and albuminuria in type 2 diabetic patients.

The study compared the effects of Losartan dose titration to 100 mg versus the addition of 12.5 mg of hydrochlorothiazide, in 90 type 2 diabetic patients with microalbuminuria and blood pressure > 130/85 mmHg, receiving losartan 50 mg as initial treatment during 4 weeks.

With the first dose of losartan, systolic (SBP) and diastolic blood pressure (DBP) decreased from 154.5 (152.1–157.5) to 144.4 (141.3–147.5) mmHg (P < 0.001) and from 91.1 (89.4–92.8) to 84.6 (82.8–86.4) mmHg (P < 0.001), with 20 patients attaining the expected goal blood pressure (< 130/85 mmHg); albuminuria decreased from 109.8 (90.5–133.3) to 83.5 (63.6–109.5) mg per 24 h (P = 0.006). Patients not attaining the target blood pressure were randomly allocated to titration or to the combination arm. After an additional 4 weeks, patients titrated exhibited a fall in SBP and DBP from 157.1 (152.7–161.5) to 142.1 (136.4–147.8) mmHg (P < 0.001) and from 92.4 (89.5–95.3) to 83.6 (81.1–86.1) mmHg (P < 0.001); albuminuria decreased from 136.3 (97.8–189.9) to 99.7 (69.3–143.4) mg per 24 h (P = 0.002). In the combination arm, there were similar reductions in SBP and DBP from 155.3 (151.5–159.1) to 139.1 (132.1–146.1) mmHg (P < 0.001) and from 92.1 (89.3–94.9) to 80.9 (77.4–84.4) mmHg (P < 0.001); while albuminuria fell from 107.7 (82.2–141.0) to 64.2 (45.9–89.9) mg per 24 h (P = 0.001).

Conclusions Losartan 50 mg was effective in reducing blood pressure and albuminuria in type 2 diabetic patients. When the blood pressure target was not reached, the two strategies tested seem to contribute similarly to further reductions in blood pressure and albuminuria.

JOURNAL OF HYPERTENSION 2002;20:715-719

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FACT  

If urine microalbumin levels are high, ACE-inhibitors should be considered even if blood pressure is normal.  (ACE)

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