Record 1 of 1 - MEDLINE EXPRESS (R) 1996-1998

TI: Long-term effect of lisinopril and atenolol on kidney function in hypertensive NIDDM subjects with diabetic nephropathy.

AU: Nielsen-FS; Rossing-P; Gall-MA; Skott-P; Smidt-UM; Parving-HH

AD: Steno Diabetes Center, Gentofte, Denmark.

SO: Diabetes. 1997 Jul; 46(7): 1182-8

ISSN: 0012-1797

PY: 1997

LA: ENGLISH

CP: UNITED-STATES

AB: The aim of our study was to evaluate whether inhibition of ACE (lisinopril 10-20 mg/day) can reduce the rate of decline in kidney function more than reducing blood pressure with conventional antihypertensive treatment (atenolol 50-100 mg/day), usually in combination with a diuretic. We performed a prospective, randomized, parallel study for 42 months, double blind for the first 12 months and single blind thereafter. Forty-three (21 lisinopril and 22 atenolol) hypertensive NIDDM patients with diabetic nephropathy were enrolled. Data from 36 patients (17 lisinopril and 19 atenolol, 60 +/- 7 years of age, 27 men) who completed at least 12 months of the study period are presented. At baseline, the two groups were comparable: glomerular filtration

rate (51Cr-EDTA plasma clearance) was 75 +/- 6 and 74 +/- 8 ml x min(-1) x 1.73 m(-2), mean 24-h ambulatory blood pressure (A&D TM2420) was 110 +/- 3 and 114 +/- 2 mmHg, and 24-h urinary albumin excretion rate was 961 (range 331-5,727) and 1,578 (476-5,806) mg/24 h in the lisinopril and atenolol groups, respectively. The mean follow-up time was similar, 37 and 35 months in the lisinopril and atenolol groups, respectively. Mean ambulatory blood pressure was equally reduced in the two groups, 12 +/- 2 and 10 +/- 2 mmHg in the lisinopril and atenolol groups, respectively. Glomerular filtration rate declined in a biphasic manner with a faster initial (0 to 6 months) change of 1.25 +/- 0.49 and 0.81 +/- 0.29 ml x min(-1) x month(-1) followed by a slower sustained decline (6 to 42 months) of 0.59 +/- 0.10 and 0.54 +/- 0.13 ml x min(-1) x month(-1) in the lisinopril and atenolol groups, respectively. No significant differences were observed in either initial or sustained decline in glomerular filtration rate between the two groups. Urinary albumin excretion was reduced (% reduction of baseline) more in the lisinopril than in the atenolol group, at 55 (95% CI 29-72) and 15% (-13 to 34), respectively (P = 0.01). In conclusion, the relentless decline in kidney function characteristically found in hypertensive NIDDM patients with diabetic nephropathy can be reduced equally effectively by two antihypertensive treatments, the beta-blocker atenolol and the ACE inhibitor lisinopril.

MESH: Aged-; Albuminuria-drug-therapy; Albuminuria-physiopathology; Angiotensin-Converting-Enzyme-Inhibitors-adverse-effects; Antihypertensive-Agents-adverse-effects; Atenolol-adverse-effects; Atenolol-therapeutic-use; Blood-Pressure-drug-effects; Blood-Pressure-physiology; Diabetes-Mellitus,-Non-Insulin-Dependent-drug-therapy; Diabetes-Mellitus,-Non-Insulin-Dependent-physiopathology; Diabetic-Nephropathies-complications; Double-Blind-Method; Follow-Up-Studies; Glomerular-Filtration-Rate; Hypertension,-Renal-physiopathology; Kidney-physiology; Lisinopril-adverse-effects; Lisinopril-therapeutic-use; Middle-Age; Prospective-Studies; Rabbits-; Single-Blind-Method; Time-Factors

MESH: *Angiotensin-Converting-Enzyme-Inhibitors-therapeutic-use; *Antihypertensive-Agents-therapeutic-use; *Diabetes-Mellitus,-Non-Insulin-Dependent-complications; *Diabetic-Nephropathies-physiopathology; *Hypertension,-Renal-drug-therapy; *Kidney-drug-effects

TG: Animal; Comparative-Study; Human; Male; Support,-Non-U.S.-Gov't

PT: CLINICAL-TRIAL; JOURNAL-ARTICLE; RANDOMIZED-CONTROLLED-TRIAL

RN: 0; 0; 29122-68-7; 83915-83-7

NM: Angiotensin-Converting-Enzyme-Inhibitors; Antihypertensive-Agents; Atenolol; Lisinopril

AN: 1997344127

UD: 199709

SB: AIM