Advances in Therapy

, Volume 23, Issue 4, pp 615–622 | Cite as

Effects of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and their combination on microalbuminuria in normotensive patients with type 2 diabetes

  • Aysegul Atmaca
  • Olcay Gedik


The goal of this study was to compare the effects of lisinopril, losartan, and their combination on microalbuminuria in normotensive patients with type 2 diabetes mellitus. Patients were randomly assigned to 3 groups: group 1 (n=9), group 2 (n=9), and group 3 (n=8) received 10 mg lisinopril, 50 mg losartan, and 10 mg lisinopril plus 50 mg losartan, respectively, each day. For 12 mo, the 24-h urine albumin excretion rate was assessed at 3-mo intervals. At study completion, the urine albumin excretion rate had been reduced significantly in each group (P=.001); however, no significant differences were noted among groups (P=.587). Investigators in the present study have concluded that lisinopril, losartan, and their combination have similar effects on microalbuminuria in normotensive patients with type 2 diabetes mellitus, and that combination therapy does not provide additional benefit.


diabetic nephropathy microalbuminuria ACE inhibitors ATII receptor blockers renoprotection 


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  1. 1.
    Dinneen SF, Gerstein H. The association of microalbuminuria and mortality in non-insulindependent diabetes mellitus: a systematic overview of the literature.Arch Intern Med. 1997; 157:1413–1418.PubMedCrossRefGoogle Scholar
  2. 2.
    McKenna K, Thompson C. Microalbuminuria: a marker to increased renal and cardiovascular risk in diabetes mellitus.Scott Med J. 1997;42:99–104.PubMedGoogle Scholar
  3. 3.
    Bjorck S, Mulec H, Johnsen SA, Norden G, Aurell M. Renal protective effect of enalapril in diabetic nephropathy.BMJ. 1992;304:339–343.PubMedCrossRefGoogle Scholar
  4. 4.
    Lewis EJ, Hunsicker LG, Bain RP, Rohde RD, for The Collaborative Study Group. The effect of angiotensin-converting enzyme inhibition on diabetic nephropathy.N Engl J Med. 1993;329: 1456–1462.PubMedCrossRefGoogle Scholar
  5. 5.
    Parving HH, Rossing P, Hommel E, Smidt UM. Angiotensin-converting enzyme inhibition in diabetic nephropathy: ten years’ experience.Am J Kidney Dis. 1995;26:99–107.PubMedGoogle Scholar
  6. 6.
    Ravid M, Lang R, Rachmani R, Lishner M. Long-term renoprotective effect of angiotensinconverting enzyme inhibition in non-insulin-dependent diabetes mellitus: a 7-year follow-up study.Arch Intern Med. 1996;156:286–289.PubMedCrossRefGoogle Scholar
  7. 7.
    The EUCLID Study Group. Randomised placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbuminuria.Lancet. 1997;349:1787–1792.CrossRefGoogle Scholar
  8. 8.
    Ahmad J, Siddiqui MA. Effective postponement of diabetic nephropathy with enalapril in normotensive type 2 diabetic patients with microalbuminuria.Diabetes Care. 1997;20:1576–1581.PubMedCrossRefGoogle Scholar
  9. 9.
    Ravid M, Brosh D, Levi Z, Bar-Dayan Y, Ravid D, Rachmani R. Use of enalapril to attenuate decline in renal function in normotensive, normoalbuminuric patients with type 2 diabetes mellitus: a randomized, controlled trial.Ann Intern Med. 1998;128:982–988.PubMedGoogle Scholar
  10. 10.
    Parving HH, Lehnert H, Bröchner-Mortensen J, Gomis R, Andersen S, Arner P, for the Irbesartan in Patients With Type 2 Diabetes and Microalbuminuria Study Group. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes.N Engl J Med. 2001;345:870–878.PubMedCrossRefGoogle Scholar
  11. 11.
    Viberti G, Wheeldon NM, for the MicroAlbuminuria Reduction With VALsartan (MARVAL) Study Investigators. Microalbuminuria reduction with valsartan in patients with type 2 diabetes mellitus: a blood pressure-independent effect.Circulation. 2002;106:672–678.PubMedCrossRefGoogle Scholar
  12. 12.
    Brenner BM, Cooper ME, de Zeeuw D, et al, for the RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy.N Engl J Med. 2001;345:861–869.PubMedCrossRefGoogle Scholar
  13. 13.
    Lewis EJ, Hunsicker LG, Clarke WR, et al, for The Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes.N Engl J Med. 2001;345:851–860.PubMedCrossRefGoogle Scholar
  14. 14.
    Hebert LA, Falkenhain ME, Nahman NS Jr, Cosio FG, O’Dorisio TM. Combination ACE inhibitor and angiotensin II receptor antagonist therapy in diabetic nephropathy.Am J Nephrol. 1999;19:1–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Mogensen CE, Neldam S, Tikkanen I, et al, for the CALM Study Group. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study.BMJ. 2000;321:1440–1444.PubMedCrossRefGoogle Scholar
  16. 16.
    Tütüncü NB, Gürlek A, Gedik O. Efficacy of ACE inhibitors and ATII receptor blockers in patients with microalbuminuria: a prospective study.Acta Diabetol. 2001;38:157–161.PubMedCrossRefGoogle Scholar
  17. 17.
    Rossing K, Christensen PK, Jensen BR, Parving HH. Dual blockade of the renin-angiotensin system in diabetic nephropathy: a randomized double-blind crossover study.Diabetes Care. 2002; 25:95–100.PubMedCrossRefGoogle Scholar
  18. 18.
    Rossing K, Jacobsen P, Pietraszek L, Parving HH. Renoprotective effects of adding angiotensin II receptor blocker to maximal recommended doses of ACE inhibitor in diabetic nephropathy: a randomized double-blind crossover trial.Diabetes Care. 2003;26:2268–2274.PubMedCrossRefGoogle Scholar
  19. 19.
    Cetinkaya R, Odabas AR, Selcuk Y. Anti-proteinuric effects of combination therapy with enalapril and losartan in patients with nephropathy due to type 2 diabetes.Int J Clin Pract. 2004;58:432–435.PubMedCrossRefGoogle Scholar
  20. 20.
    Hollenberg NK, Fisher NDL, Price DA. Pathways for angiotensin II generation in intact human tissue: evidence from comparative pharmacological interruption of the renin system.Hypertension. 1998;32:387–392.PubMedGoogle Scholar
  21. 21.
    Mogyorósi A, Sonkodi S. AT1 receptor antagonists: a challenge for ACE inhibitors in diabetic nephropathy.Diabetes Metab Res Rev. 1999;15:55–58.PubMedCrossRefGoogle Scholar
  22. 22.
    Pugliese G, Pricci F, Pugliese F, et al. Mechanisms of glucose-enhanced extracellular matrix accumulation in rat glomerular mesangial cells.Diabetes. 1994;43:478–490.PubMedCrossRefGoogle Scholar
  23. 23.
    Goodfriend TL, Elliott ME, Catt KJ. Angiotensin receptors and their antagonists.N Engl J Med. 1996;334:1649–1654.PubMedCrossRefGoogle Scholar

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© Springer Science and Business Media and LLC 2006

Authors and Affiliations

  • Aysegul Atmaca
    • 1
  • Olcay Gedik
    • 1
  1. 1.Department of Endocrinology and MetabolismHacettepe University Faculty of MedicineAnkaraTurkey

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