Long-Term Enalapril Slows Disease Damage In Diabetics
Enalapril treatment resulted in an absolute risk
reduction of 22.4 percentage points for the development
of clinical albuminuria over five years.
Long-term treatment with enalapril, an angiotensin-converting
enzyme inhibitor, may reduce or delay the progression
of structural glomerular damage in microalbuminuric
diabetics who do not have marked hypertension.
Endocrinologists at Aligarh Muslim University, India,
drew this conclusion as the result of a 5-year, double-blind,
placebo-controlled study investigating what effect
enalapril had on renal function and histology in
type 1 diabetics with microalbuminuria.
Seventy
three type 1 diabetics whose blood pressure was
less than <140/90 mm Hg and who had persistent
albuminuria (albumin excretion rate 20-200 micrograms/min)
and normal renal function were randomly assigned
to receive either enalapril or placebo.
A percutaneous renal biopsy was successfully performed
in 69 patients. After 5 years, this was repeated
in 59 patients. Patients' mean glomerular volume,
mesangial volume and glomerular basement membrane
thickness were all measured.
Before treatment, the active drug and placebo groups
had similar clinical characteristics, blood pressure,
HbA1c, albumin excretion rate, glomerular filtration
rate, serum creatinine and renal structural damage.
Blood pressure was well controlled in both groups.
Albuminuria fell significantly in the 37 patients
given enalapril, with only 3 patients (8.1%) progressing
to clinical albuminuria (albumin excretion rate exceeding
300 mg. per 24 hours). That compared with 11 of the
36 patients (30.5%) given placebo.
Enalapril treatment resulted in an absolute risk
reduction of 22.4 percentage points for the development
of clinical albuminuria over five years.
After 5 years of treatment, glomerular basement
membrane thickness showed a consistent, though not
statistically significant, rise in the placebo group
but remained stable in enalapril recipients.
At the end of the study, the specialists observed
a significant rise in mean glomerular volume and
mesangial volume among patients given placebo.
Diabetes Research and Clinical Practice 2003;60:2:131-138
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