CAPTOPRIL REDUCES THE RISK OF NEPHROPATHY IN IDDM PATIENTS WITH MICROALBUMINURIA

BONER G VANDYK DJ TAN MH TAN J EKSTRAND A KOIVISTO VA GROOP LC GROOP PH LUCAS A ROMERO R SALINAS I SANMARTI A ESCOBAR F ESCOBARJIMENEZ F CAMPOSPASTOR MM MUGOZ M GOMEZ M MANGILI R POZZA G SPOTTI D HANSEN KW CHRISTIANSEN JS KLEIN F MOGENSEN CE ZIEKENHUIS M VANDOORN LG SPOOREN PFMJ CRUICKSHANK JK JERVELL J PAUS PN BARNES DJ COLLINS A VIBERTI GC WILLIAMS G NELSTROP GA AMOROSA L ANOLIK JR ARONOFF SL EUBANK B BAILIE M PELLETIER L BLEVINS T CHARLES MA PERRY M CLARKE D TOMKEY D EINHORN D HUMPHRIES D GARBER AJ HAAG B WILLIAMS E HOY W WATKINS M KAHKONEN D KRUGER D KILO C LAFFEL L GOLDEN E LODEWICK P LOVINSKY D MASON J JOHNSON S MCGILL J SCHMIDT L ORLANDER P SORENSON K RASKIN P HELLENBRAND D ROSENBLATT S SCHWARTZ S AUFIERI J SHEEHAN JP ULCHAKER M SKYLER JS AGRAMONTE R STARR J GAGLIASTRE D TAYLOR T DAWN K WARD WK RIGDON M COOPER M GANS DJ

G. Boner et al., CAPTOPRIL REDUCES THE RISK OF NEPHROPATHY IN IDDM PATIENTS WITH MICROALBUMINURIA, Diabetologia, 39(5), 1996, pp. 587-593

44

INGLESE

Article

Endocrynology & Metabolism","Medicine, General & Internal

Diabetologia → ACNP

0012-186X

39

5

1996

587 - 593

ISI

0012-186X(1996)39:5<587:CRTRON>2.0.ZU;2-U

In insulin-dependent diabetes mellitus (IDDM), microalbuminuria predic ts renal and cardiovascular disease. We report a combined analysis of 235 normotensive IDDM patients with microalbuminuria who participated in two 24-month double-blind, randomised, placebo-controlled trials to assess the effects of captopril 50 mg twice daily on the progression to overt clinical albuminuria. Of the 225 patients who were evaluable on an intent to treat basis, 25 of 114 placebo-treated patients (21.9% ) and 8 of 111 captopril-treated patients (7.2%) progressed to persist ent clinical albuminuria. The risk of progression over 24 months was s ignificantly reduced by captopril (p = 0.004) with a risk reduction of 69.2% (95% confidence interval (CI): 31.7 to 86.1%). This degree of r isk reduction remained at the same level (62.9% [16.1-83.6%], p = 0.01 7) after adjustment for differences in time-varying mean arterial bloo d pressure. Albumin excretion rate increased by an average of 14.2% [3 .1-26.5%] per year in the placebo-treated group compared with a reduct ion of 9.6% [-18.6-0.4%] per year in the captopril-treated group (p = 0.002). The rate of fall of creatinine clearance tended to be faster i n the placebo-treated group than in the captopril-treated group (-6.4 [-10.2--2.5] vs -1.4 [-5.3-2.6] ml . min(-1). 1.73 m(-2), p = 0.07). B aseline albumin excretion rate (p < 0.0001) and glycated haemoglobin ( p = 0.03) were independent predictors of progression to clinical album inuria and changes in mean arterial blood pressure (p = 0.02) and seru m cholesterol level (p = 0.003) were significantly associated with per centage changes in albumin excretion rate. Captopril reduces the risk of progression to overt nephropathy in IDDM patients with microalbumin uria, an effect partly independent of its blood pressure-lowering effe cts.