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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