Diabetic microalbuminuria delayed by ACE inhibitor

Abstract

Angiotensin-converting enzyme (ACE) inhibitors are already known to slow the development of overt diabetic nephropathy in patients with type 2 diabetes mellitus (T2DM) with hypertension or in normotensive patients with T1DM. However, the effectiveness of other antihypertensive drugs has not been fully clarified. A recent comparison of perindopril, an ACE inhibitor, with nifedipine, a calcium-channel blocker, has shown that perindopril was more effective at slowing the progression of this condition in normotensive diabetics.Writing in the American Journal of Kidney Disease (May issue), George Jerums (University of Melbourne, VIC, Australia) and colleagues compared the results of 36 months of treatment with either perindopril or nifedipine of 33 normotensive patients with T1DM. Whereas there was no difference in mean arterial pressure, or changes in the levels of cholesterol, triglyceride or glycosylated hemoglobin between the two groups, albumin excretion rates (AER) progressively increased in both the nifedipine and placebo groups (reaching a median of 122 μg min−1 and 112 μg min−1 respectively) and declined in most of the patients receiving perindopril (a median of 23 μg min−1 was recorded).Compared with the four nifedipine-treated and three placebo-treated patients, only one perindopril-treated patient developed macroalbuminuria. Seven perindopril-treated patients regressed to normoalbuminuria compared with none of the other patients.That the use of an ACE inhibitor was more effective than were dihydropyridine calcium-channel blockers in slowing the long-term progression of albuminuria suggests that ACE inhibitors should be used as treatment for normotensive microalbuminuric patients with T1DM. However, Jerums et al. are quick to caution whether such functional effects of ACE inhibition are associated with protective effects on renal structure. LS