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Long-term ACE Inhibitor Treatment Promotes Renal Health and Imp

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.