Long-term ACE Inhibitor Treatment
Promotes Renal Health and Improves Lipid Profiles
Long-term therapy with an angiotensin-converting
enzyme (ACE) inhibitor appears to reduce urinary
albumin excretion and improve lipid metabolism
in patients with hypertension, research findings
suggest.
As physicians come to understand the role of
ACE inhibitors in hypertension, the long-term
view is showing the potential of this drug class
to address both microalbuminuria and lipid profiles,
according to Hiroshi Shionoiri, MD, an attending
nephrologist at Yokohama City University School
of Medicine, in Yokohama, Japan.
ACE inhibitors might have a greater effect on
urinary albumin excretion and lipid levels than
both diuretics and calcium channel blockers, Dr.
Shionoiri reported June 10th at the World Congress
of Nephrology.
To compare the effects of long-term treatment
with an ACE inhibitor, a diuretic, or a calcium-channel
blocker on urinary microalbumin excretion rate
and serum lipid profiles, the study investigators
enrolled 139 nondiabetic patients with hypertension
and no renal impairment.
Subjects had been treated previously with either
the diuretic trichlormethiazide 2 mg/day or a
calcium-channel blocker -- amlodipine 5 mg/day,
nitrendipine 10 mg/day, or nisoldipine 10 mg/day
-- for at least 6 months before the study.
After patients underwent 3 months of baseline
observation while the previous treatment continued,
the investigators randomly assigned them into
1 of 4 groups. Thirty-nine patients continued
their diuretic treatment for an additional 12
months; 37 patients switched from the diuretic
to the ACE inhibitor temocapril for 12 months
at a dosage of 2-4 mg/day; 32 patients continued
their calcium-channel blocker for an additional
12 months; 31 patients switched from their calcium-channel
blocker to temocapril at 2-4 mg/day for 12 months.
The investigators measured patients' blood pressure,
lipid profiles, and urinary albumin excretion.
They expressed urinary albumin excretion as a
ratio between milligrams of excreted urinary albumin
per gram of creatinine. In previous work, the
investigators had estimated the upper normal value
of urinary albumin excretion to be 29.5.
All treatments appeared to have similar blood
pressure-lowering effects, the authors reported.
However, patients who were switched to temocapril
had significantly decreased urinary albumin excretion
from the baseline values. In the group switched
from a diuretic, the mean urinary albumin excretion
was reduced from 37.0 to 23.2 at 12 months. In
that same time period, the urinary albumin excretion
decreased from 38.9 to 25.3 in the group switched
from calcium-channel blockers (P<0.01).
By contrast, the groups that remained either
on a diuretic or a calcium-channel blocker had
no significant change in mean urinary albumin
excretion rate.
After switching to temocapril, serum total cholesterol
in the switched groups was significantly decreased
from the baseline value (P<0.05) -- from 223.5
mg/dL to 210.7 mg/dL in the group switched from
diuretics; from 215.6 mg/dL to 209.3 mg/dL in
the group switched from calcium-channel blockers.
Serum levels of low-density lipoprotein and high-density
lipoprotein were also improved in the switched
groups, the authors reported. The cholesterol
values were unchanged in the continuation groups,
they added.
[Study title: Long-Term Therapy With An Angiotensin-Converting
Enzyme Inhibitor, Temocapril, Seems To Be Beneficial
On Microalbuminuria And On Lipid Profiles When
Compared With Those Of Diuretic Or Calcium-Channel
Blocker In Non-Diabetic Hypertensives. Abstract
T243]
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FACT:
Both generalists and specialists are more likely
to miss a diagnosis of peripheral neuropathy than
not to miss it, a new analysis of data from a
large cohort study suggests. In the analysis of
nearly 7,500 patients, both primary care physicians
and endocrinologists failed to diagnose nonsevere
neuropathy in about two thirds of cases, reported
a team led by William H. Herman, MD, MPH, professor
of internal medicine at the University of Michigan
at Ann Arbor.
ADA 63rd Scientific Session: Abstract 830-P. Presented
June 14, 2003.
