Skip to main content
SpringerLink
Log in

Effects of Amlodipine vs Enalapril on Microalbuminuria in Hypertensive Patients with Type II Diabetes

  • Section 1: Pharmacodynamic Profile
  • Published:
Clinical Drug Investigation Aims and scope Submit manuscript

Summary

The effects of once-daily amlodipine 10mg or enalapril 20mg on urinary albumin excretion (UAE) were evaluated over 12 months, in a randomised trial of 50 hypertensive patients with type II (non-insulin-dependent) diabetes mellitus and microalbuminuria. Both drugs significantly reduced systolic and diastolic blood pressure without affecting heart rate or glucose homeostasis. UAE was significantly reduced after 3 months of treatment with enalapril, and 6 months of therapy with amlodipine. The percentage reduction in UAE significantly correlated with the decrement in systolic blood pressure and duration of hypertension in both treatment groups. Creatinine clearance was unaffected by enalapril, but was significantly increased by amlodipine. Long term treatment with either amlodipine or enalapril was therefore effective in reducing UAE in hypertensive patients with type II diabetes and microalbuminuria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Viberti GC, Hill RD, Jarret RJ, et al. Microalbuminuria as a predictor of clinical nephropathy in insulin dependent diabetes mellitus. Lancet 1982; 1: 1430–2

    Article  PubMed  CAS  Google Scholar 

  2. Parving HH, Oxenboll B, Svendsen PA, et al. Early detection of patients at risk of developing diabetic nephropathy: a longitudinal study of urinary albumin excretion. Acta Endocrinol 1982; 100: 550–5

    PubMed  CAS  Google Scholar 

  3. Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 1984; 310: 356–60

    Article  PubMed  CAS  Google Scholar 

  4. Tuttle KR, Stein JH, De Fronzo RA. The natural history of diabetic nephropathy. Semin Nephrol 1990; 10: 184–93

    PubMed  CAS  Google Scholar 

  5. Ritz E. Hypertension in diabetic nephropathy: prevention and treatment. Am Heart J 1993; 125: 1514–9

    Article  PubMed  CAS  Google Scholar 

  6. Jarret RJ, Viberti GC, Argyropoulos A, et al. Microalbuminuria predicts mortality in non-insulin-dependent diabetes. Diab Med 1984; 1: 17–9

    Article  Google Scholar 

  7. Schmitz A, Vaeth M. Microalbuminuria: a major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients. Diab Med 1988; 5: 126–34

    Article  CAS  Google Scholar 

  8. Mattock MB, Keen H, Viberti G, et al. Coronary heart disease and urinary albumin excretion rate in type 2 (non-insulin-dependent) diabetic patients. Diabetologia 1988; 31: 82–7

    Article  PubMed  CAS  Google Scholar 

  9. Viberti GC. Etiology and prognostic significance of microalbuminuria in diabetes. Diabetes Care 1988; 11: 840–5

    Article  PubMed  CAS  Google Scholar 

  10. Allawi J, Jarret RJ. Microalbuminuria and cardiovascular risk factors in type II diabetes mellitus. Diabetic Med 1990; 7: 115–8

    Article  PubMed  CAS  Google Scholar 

  11. Epstein M, Sowers JR. Diabetes mellitus and hypertension. Hypertension 1992; 19: 402–18

    Article  Google Scholar 

  12. Mogensen CE. Long-term antihypertensive treatment inhibiting progression of diabetic nephropathy. BMJ 1982; 285: 685–8

    Article  PubMed  CAS  Google Scholar 

  13. Parving HH, Andersen AR, Smidt U, et al. Effects of antihypertensive treatment on kidney function in diabetic nephropathy. BMJ 1987; 294: 1443–7

    Article  PubMed  CAS  Google Scholar 

  14. Fuller JH, Head J, and the WHO Multinational Study Group. Blood pressure, proteinuria and their relationship with circulatory mortality: the WHO multinational study of vascular disease in diabetics. Diab Metab 1989; 15: 273–7

    CAS  Google Scholar 

  15. Mathiesen E, Ronn B, Jensen T, et al. Relationship between blood pressure and urinary albumin excretion in development of microalbuminuria. Diabetes 1990; 39: 245–9

    Article  PubMed  CAS  Google Scholar 

  16. Ribstein J, Mimran A. Blood pressure reduction as a preventive treatment of diabetic nephropathy. Clin Invest Med 1991; 14: 661–70

    PubMed  CAS  Google Scholar 

  17. Zatz R, Dunn BR, Meyer TW, et al. Prevention of diabetic glomerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 1986; 77: 1925–30

    Article  PubMed  CAS  Google Scholar 

  18. Myers BD, Meyer TW. Angiotensin converting enzyme inhibitors in the prevention of experimental diabetic glomerulopathy. Am J Kidney Dis 1989; 13: 20–4

    PubMed  CAS  Google Scholar 

  19. Reams GP, Bauer JH. Effect of enalapril in subjects with hypertension associated with moderate to severe renal dysfunction. Arch Intern Med 1986; 146: 2145–8

    Article  PubMed  CAS  Google Scholar 

  20. Heeg JE, De Jong PE, Vander Mem GK, et al. Reduction of proteinuria by ACE inhibition. Kidney Int 1987; 32: 78–83

    Article  PubMed  CAS  Google Scholar 

  21. Abraham PA, Opsahl JA, Halstenson CE, et al. Efficacy and renal effects of enalapril therapy for hypertensive patients with chronic renal insufficiency. Arch Intern Med 1988; 148: 2358–62

    Article  PubMed  CAS  Google Scholar 

  22. Heeg JE, De Jong PE, Van Der Hemm GK, et al. Efficacy and variability of the antiproteinuric effect of ACE inhibition by lisinopril. Kidney Int 1989; 36: 272–9

    Article  PubMed  CAS  Google Scholar 

  23. Keane WF, Anderson S, Aurell M, et al. Angiotensin converting enzyme inhibition and progressive renal insufficiency. Ann Intern Med 1989; 111: 503–16

    PubMed  CAS  Google Scholar 

  24. Bianchi S, Bigazzi R, Baldari G, et al. Long-term effects of enalapril and nicardipine on urinary albumin excretion in patients with chronic renal insufficiency: a 1-year follow-up. Am J Nephrol 1991; 11: 131–7

    Article  PubMed  CAS  Google Scholar 

  25. Taguma Y, Kitamoto Y, Futaki G, et al. Effect of Captopril on heavy proteinuria in systemic diabetics. N Engl J Med 1985; 313: 1617–20

    Article  PubMed  CAS  Google Scholar 

  26. Hommel E, Parving HH, Mathiesen E, et al. Effect of Captopril on kidney function in insulin-dependent diabetic patients with nephropathy. BMJ 1986; 293: 467–70

    Article  PubMed  CAS  Google Scholar 

  27. Marre M, Chatellier G, Leblanc H, et al. Prevention of diabetic nephropathy with enalapril in normotensive diabetes with microalbuminuria. BMJ 1988; 297: 1092–5

    Article  PubMed  CAS  Google Scholar 

  28. Parving HH, Hommel E, Smidt VM. Protection of kidney function and decrease in albuminuria by Captopril in insulin dependent diabetics with nephropathy. BMJ 1988; 297: 1086–91

    Article  PubMed  CAS  Google Scholar 

  29. Baba T, Murabayashi S, Takabe K. Comparison of the renal effects of angiotensin converting enzyme inhibitor and calcium antagonist in hypertensive type II (non-insulin-dependent) diabetic patients with microalbuminuria: a randomized, controlled trial. Diabetologia 1989; 32: 40–4

    PubMed  CAS  Google Scholar 

  30. Stornello M, Valvo EV, Scapellato L. Haemodynamic,renal and humoral effects of the calcium-entry-blocker nicardipine and converting enzyme inhibitor Captopril in hypertensive type II diabetic patients with nephropathy. J Cardiovasc Pharmacol 1989; 14: 851–5

    Article  PubMed  CAS  Google Scholar 

  31. Holdaas H, Hartmann A, Lien MG, et al. Contrasting effects of lisinopril and nifedipine on albuminuria and tubular transport function in insulin dependent diabetics with nephropathy. J Intern Med 1991; 229: 163–70

    Article  PubMed  CAS  Google Scholar 

  32. Marre M, Hallab M, Billiard A, et al. Small doses of ramipril to reduce microalbuminuria in diabetic patients with incipient nephropathy independently of blood pressure changes. J Cardiovasc Pharmacol 1991; 18 Suppl. 2: S165–8

    PubMed  Google Scholar 

  33. Mathiesen ER, Hommel E, Giese J, et al. Efficacy of Captopril in postponing nephropathy in normotensive insulin dependent diabetic patients with microalbuminuria. BMJ 1991; 303: 81–7

    Article  PubMed  CAS  Google Scholar 

  34. Ferder L, Daccordi H, Martello M, et al. Angiotensin converting enzyme inhibitors vs Ca-antagonists in the treatment of diabetic hypertensive patients. Hypertension 1992; 19 Suppl. II: 237–42

    Google Scholar 

  35. Stornello M, Valvo E, Scapellato L. Persistent albuminuria in normotensive non-insulin-dependent (type II) diabetic patients: comparative effects of ACE-inhibitors and beta-adrenoceptor blockers. Clin Sci 1992; 82: 19–23

    PubMed  CAS  Google Scholar 

  36. Wiegmann TB, Gish Herron K, Chonko AM, et al. Effect of angiotensin converting enzyme inhibition on renal function and albuminuria in normotensive type I diabetic patients. Diabetes 1982; 41: 62–7

    Article  Google Scholar 

  37. Harris DC, Hammond WS, Burke TJ, et al. Verapamil protects against progression of experimental chronic renal failure. Kidney Int 1987; 31: 41–6

    Article  PubMed  CAS  Google Scholar 

  38. Pelayo JC, Harris DC, Shanley PF, et al. Glomerular haemodynamic adaptation in remnant nephrons: effects of verapamil. Am J Physiol 1988; 254: F425–31

    PubMed  CAS  Google Scholar 

  39. Whitty MR, Jackson B. Diabetic nephropathy in the rat: differing renal effects of an angiotensin converting enzyme inhibitor and a calcium inhibitor. Diabetes Res 1988; 8: 91–6

    PubMed  CAS  Google Scholar 

  40. Dworkin LD, Benstein JA. Impact of antihypertensive therapy on progressive kidney damage. Am J Hypertens 1989; 2 Suppl.: 162–72

    Google Scholar 

  41. Bakris GL. Effects of diltiazem or lisinopril on massive proteinuria associated with diabetes mellitus. Ann Intern Med 1990; 112: 707–8

    PubMed  CAS  Google Scholar 

  42. Bakris GL. Diltiazem decreases urinary protein excretion in patients with diabetes nephropathy [abstract]. Am J Hypertens 1990; 3: 97

    Google Scholar 

  43. Melbourne Diabetic Nephropathy Study Group. Comparison between Perindopril and nifedipine in hypertensive and normotensive diabetic patients with microalbuminuria. BMJ 1991; 302: 210–6

    Article  Google Scholar 

  44. Jerums G, Allen TJ, Tsalamandris C, et al. Angiotensin converting enzyme inhibition and calcium channel blockade in incipient diabetic nephropathy. Kidney Int 1992; 41: 904–11

    Article  PubMed  CAS  Google Scholar 

  45. Reams GP, Hamory A, Lau A, et al. Effect of nifedipine on renal function in patients with essential hypertension. Hypertension 1988; 11: 452–6

    Article  PubMed  CAS  Google Scholar 

  46. Ferrier C, Ferrari P, Weidmann P, et al. Antihypertensive therapy with the calcium-channel-blocker verapamil and/or the angiotensin-converting-enzyme-inhibitor enalapril in diabetic patients. Diabetes Care 1991; 14: 911–4

    Article  PubMed  CAS  Google Scholar 

  47. Mimran A, Insua A, Ribstein J, et al. Comparative effects of Captopril and nifedipine in normotensive patients with incipient diabetic nephropathy. Diabetes Care 1988; 11: 850–3

    Article  PubMed  CAS  Google Scholar 

  48. Bauer JH, Reams GP. Do calcium antagonists protect the human hypertensive kidney? Am J Hypertens 1989; 2 Suppl.: 173–8

    Google Scholar 

  49. De Marie BK, Bakris GC. Effects of different classes of calcium antagonists on proteinuria in diabetic subjects. Ann Intern Med 1990; 113: 987–8

    Google Scholar 

  50. Burges RA, Dodd MG. Amlodipine. Drugs Rev 1990; 8: 25–44

    CAS  Google Scholar 

  51. National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979; 281: 1039–57

    Google Scholar 

  52. Christensen C, Mogensen CE. Effect of antihypertensive treatment on progression of incipient diabetic nephropathy. Hypertension 1985; 7 Suppl. II: 109–13

    Google Scholar 

  53. Loutzenhiser RD, Epstein M, Horton C, et al. Reversal by the calcium-antagonist nisoldipine of norepinephrine-induced reduction of GFR: evidence for preferential antagonism on pre-glomerular vasoconstriction. J Pharmacol Exp Ther 1985; 232: 382–7

    PubMed  CAS  Google Scholar 

  54. Loutzenhiser RD, Epstein M, Fischetti F, et al. Effects of amlodipine on renal haemodynamics. Am J Cardiol 1989; 64: 122–81

    Article  Google Scholar 

  55. Epstein M. Calcium antagonists and the kidney. Implications for renal protection. Am J Hypertens 1991; 4: 482–6S

    Google Scholar 

  56. Raij L, Keane WF, Oswald H, et al. Glomerular mesangium function and relationship to angiotensin II. Am J Med 1985; 79 Suppl. 3c: 24–30

    Article  PubMed  CAS  Google Scholar 

  57. Morelli E, Loon N, Meyer T, et al. Effects of converting enzyme inhibition on barrier function in diabetic glomerulopathy. Diabetes 1990; 39: 76–82

    Article  PubMed  CAS  Google Scholar 

  58. Remuzzi A, Puntorieri S, Battaglia C, et al. Angiotensin converting enzyme inhibition ameliorates glomerular filtration of macromolecules and water and lessens glomerular injury in the rat. J Clin Invest 1990; 85: 54–9

    Article  Google Scholar 

  59. Schultz PJ, Raij L. Inhibition of human mesangial cell proliferation by calcium channel blockers. Hypertension 1990; 15 Suppl. I: 76–80

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy

    Roberto Fogari, A. Zoppi, G. D. Malamani, P. Lusardi, M. Destro & L. Corradi

Authors
  1. Roberto Fogari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Zoppi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. D. Malamani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Lusardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Destro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Corradi
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fogari, R., Zoppi, A., Malamani, G.D. et al. Effects of Amlodipine vs Enalapril on Microalbuminuria in Hypertensive Patients with Type II Diabetes. Clin. Drug Invest. 13 (Suppl 1), 42–49 (1997). https://doi.org/10.2165/00044011-199700131-00009

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00044011-199700131-00009

Keywords

Search

Navigation