Abstract
To examine the effect of low-dose losartan, an angiotensin II antagonist, on persistent microalbuminuria in normotensive Type 1 diabetes mellitus, 16 subjects with Type 1 diabetes were randomly assigned to two 2-month treatment periods, with either losartan (25 mg/day) or enalapril (5 mg/day) in a single-blind cross-over design. Urinary albumin excretion (UAE), blood pressures, lipids, glycemia, HbA1c, serum potassium and creatinine clearance were measured before and after each treatment period. The UAEs were similarly reduced after both treatments. The median UAE decreased by 27.8%, from 162 (range 65–250) to 117 (34–190) mg/day (p<0.01) after enalapril, and decreased by 25%, from 160 (60–246) to 120 (36–184) mg/day (p<0.01) after losartan. The systolic and diastolic blood pressures also decreased significantly (p<0.05), whereas serum levels of potassium increased (p<0.01) after both treatments. The levels of serum HbA1c, mean fasting glucose, total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol and creatinine clearances were not significantly (p>0.05 in all) changed by either the enalapril or losartan treatment. No significant differences were found between the effects of enalapril and losartan. In conclusion, losartan treatment reduces microalbuminuria as effectively as enalapril in normotensive Type 1 diabetic patients.
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References
Viberti G., Mogensen C.E., Groop L.C., Pauls J.F. Effect of captopril on progression to clinical pro-teinuria in patients with insulin-dependent diabetes mellitus and microalbuminuria. JAMA 1994, 271: 275–279.
The Microalbuminuria Captopril Study Group. Captopril reduces the risk of nephropathy in IDDM patients with microalbuminuria. Diabetologia 1996, 39: 587–593.
Ravid M., Savin H., Jutrin I., Bental T., Katz B., Lishner M. Longterm stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann. Intern. Med. 1993, 118: 577–581.
Ahmad J., Siddiqui M.A., Ahmad H. Effective postopenement of diabetic nephropathy with enalapril in normotensive type 2 diabetic patients with microalbuminuria. Diabetes Care 1997, 20: 1576–1581.
Allen T.J., Cao Z., Youssef S., Hulthen U.L., Cooper M.E. The role of angiotensin II and bradykinin in experimental diabetic nephropathy: functional and structural studies. Diabetes 1997, 46: 1612–1618.
The Diabetes Control and Complications (DCCT) Research Group. Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. Kidney Int. 1995, 47: 1703–1720.
Pedrini M.T., Levey A.S., Lau J., Chalmers T.C., Wang P.H. The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases: a meta analysis. Ann. Intern. Med. 1996, 124: 627–632.
Friedewald W.T., Levy R.I., Fredrickson D.S. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin. Chem. 1972, 18: 499–502.
Cooper M.E. Pathogenesis, prevention, and treatment of diabetic nephropathy. Lancet 1998, 352: 213–219.
Mogensen C.E., Keane W.F., Bennett P.H., Jerums G., Parving H.H., Passa P., Steffes M.W., Striker G.E., Viberti G.C. Prevention of diabetic renal disease with special reference to microalbuminuria. Lancet 1995, 346: 1080–1084.
Goodfriend T.L, Elliott M.E., Catt K.J. Angiotensin receptors and their antagonists. N. Engl. J. Med. 1996, 334: 1649–1654.
Tikkanen I., Omvik P., Jensen H.A.E. Comparison of the angiotensin II antagonist losartan with the angiotensin converting enzyme inhibitor enalapril in patients with essential hypertension. J. Hypertens. 1995, 13: 1343–1351.
Remuzzi A., Perico N., Amuchastegui C.S., Malanchini B., Mazerska M., Battaglia C., Bertani T., Remuzzi G. Short- and long-term effect of angiotensin II receptor blockade in rats with experimental diabetes. J. Am. Soc. Nephrol. 1993, 4: 40–49.
Kedziora-Kornatowska K. Effect of angiotensin convertase inhibitors and AT1 angiotensin receptor antagonists on the development of oxidative stress in the kidney of diabetic rats. Clin. Chem. Acta 1999, 287: 19–27.
Andersen S., Tarnow L., Rossing P., Hansen B.V., Parving H.H. Renoprotective effects of angiotensin II receptor blockade in type 1 diabetic patients with diabetic nephropathy. Kidney Int. 2000, 57: 601–606.
Burnier M., Brunner H.R. Angiotensin II receptor antagonists. Lancet 2000, 355: 637–645.
Lacourciere Y., Belanger A., Godin C., Halle J.P., Ross S., Wright N., Marion J. Long-term comparison of losartan and enalapril on kidney function in hypertensive Type 2 diabetics with early nephropathy. Kidney Int. 2000, 58: 762–769.
Paterna S., Parrinello G., Scaglione R., Costa R., Bova A., Palumbo V.A., Pinto A., Amato P., Licata G. Effect of long-term losartan administration on renal haemodynamics and function in hypertensive patients. Cardiovasc. Drugs Ther. 2000, 14: 529–532.
Chan J.C., Critchley J.A., Tomlinson B., Chan T.Y., Cockram C.S. Antihypertensive and anti-albuminuric effects of losartan potassium and felodipine in Chinese elderly hypertensive patients with or without non-insulin-dependent diabetes mellitus. Am. J. Nephrol. 1997, 17: 72–80.
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Açbay, Ö. Effects of low-dose losartan treatment on persistent microalbuminuria in normotensive Type 1 diabetic subjects. J Endocrinol Invest 24, 608–611 (2001). https://doi.org/10.1007/BF03343901
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DOI: https://doi.org/10.1007/BF03343901