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Comparative Study of the Effect of Ace Inhibitors and other Antihypertensive Agents on Proteinuria in Diabetic Patients

  • L. Böhlen
  • M. Schneider
  • M. De Courten
  • P. Weidmann

Abstract

In Europe, >25 million persons may have diabetes mellitus (DM), 10% of them type 1 (insulin-dependent) and 90% type 2 (non-insulin-dependent). Diabetics also commonly have hypertension and dyslipidemia and, therefore, are particularly prone to micro- and macrovascular complications, invalidity and early death. In fact, cardiovascular mortality is increased more than 2-fold in diabetics with hypertension and/or microalbuminuria [1–3], and up to a staggering 35-fold once the latter has progressed to clinical nephropathy [4,5].

Keywords

Glomerular Filtration Rate Diabetic Nephropathy Calcium Antagonist Filtration Fraction Antiproteinuric Effect 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Wilson PW, Cupples LA and Kannel WB. Is hyperglycemia associated with cardiovascular disease? Am Heart J 1991; 121: 586–590.PubMedCrossRefGoogle Scholar
  2. 2.
    Morrish NJ, Stevens LK, Head J, et al. A prospective study on mortality among middle-aged diabetic patients. Diabetologia 1990; 33: 542–548.PubMedCrossRefGoogle Scholar
  3. 3.
    Judkin JS. »Microalbuminuria in vascular disease.« In Microalbuminuria, a Marker for Organ Damage. Mogensen CE, ed. Science Press, 1993; pp 69-80.Google Scholar
  4. 4.
    Borch-Johnsen K and Kreiner S. Proteinuria: value as a predictor of cardiovascular mortality in insulin-dependent diabetes mellitus. BMJ 1987; 294: 230–233.CrossRefGoogle Scholar
  5. 5.
    Parving HH and Hommel E. Prognosis in diabetic nephropathy. BMJ 1989; 299: 230–33.PubMedCrossRefGoogle Scholar
  6. 6.
    Epstein M and Sowers JR. Diabetes mellitus and hypertension. Hypertension 1992; 19: 403–418.PubMedCrossRefGoogle Scholar
  7. 7.
    Mogensen CE and Hansen KW. Preventing and postponing renal disease in insulin-dependent diabetes by glycémic an non-glycemic intervention. Contr Nephrol 1990; 78: 73–100.Google Scholar
  8. 8.
    Centers for Disease Control. End-stage renal disease associated with diabetes. United States 1988. Morb Mortal Wkly Rep 1989; 38: 546–48.Google Scholar
  9. 9.
    Vora JP, Anderson S and Brenner BM. »Pathogenesis of diabetic glomerulopathy: the role of glomerular hemodynamic factors.« In The Kidney and Hypertension in Diabetes Mellitus, 2nd ed, Mogensen CE, ed. Boston, Dordrecht, London: Kluwer Academic Publishers, 1994; pp 323–332.Google Scholar
  10. 10.
    Feldt-Rasmussen B, Borch-Johnsen K and Mathiesen ER. Hypertension in diabetes as related to nephropathy. Hypertension 1985; 7: Suppl. II: II18–II20.PubMedGoogle Scholar
  11. 11.
    Viberti G, Yip-Messent J and Morocutti A. Diabetic nephropathy. Diabetes Care 1992; 15: 1215–1225.CrossRefGoogle Scholar
  12. 12.
    Weidmann P, Böhlen LM and de Courten M. Pathogenesis and treatment of hypertension associated with diabetes mellitus. Am Heart J 1993; 125: 1498–1513.PubMedCrossRefGoogle Scholar
  13. 13.
    The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993; 329: 977–986.CrossRefGoogle Scholar
  14. 14.
    Zeller K, Whittacer E, Sullivan L, et al. Effect of restricting dietary protein in the progression of renal failure in patients with insulin-dependent diabetes mellitus. N Engl J Med 1991; 324: 78–84.PubMedCrossRefGoogle Scholar
  15. 15.
    de Courten M, Böhlen L and Weidmann P. Antihypertensive treatment of diabetic and nondiabetic renal disease: drug-specific differences in reducing proteinuria. J Hypertension 1994; 12: Suppl. 3: S112.Google Scholar
  16. 16.
    Böhlen L, de Courten M and Weidmann P. Comparative study of the effect of ACE-inhibitors and other antihypertensive agents on proteinuria in diabetic patients. Am J Hypertension 1994; 7: S84–S92.Google Scholar
  17. 17.
    Weidmann P, Böhlen L, de Courten M, et al. Antihypertensive therapy in diabetic patients. J Human Hypertension 1992; 6: Suppl. 2: S23–S36.Google Scholar
  18. 18.
    Weidmann P, Böhlen L, de Courten M, et al. Effects of different antihypertensive drugs on human diabetic proteinuria. Nephrol Dial Transplant 1993; 8: 582–584.PubMedGoogle Scholar
  19. 19.
    Weidmann P, Schneider M and Böhlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: an up-dated meta-analysis. Nephrol Dial Transplant 1996; in press.Google Scholar
  20. 20.
    De Cesaris R, Ranieri G, Filitti V, et al. Effects of atenolol and enalapril on kidney function in hypertensive diabetic patients. J Cardiovasc Pharmacol 1993; 22: 208–214.PubMedCrossRefGoogle Scholar
  21. 21.
    Lewis EJ, Hunsicker LG, Bain RP, et al. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med 1993; 329: 1456–1462.PubMedCrossRefGoogle Scholar
  22. 22.
    O’Donnell MJ, Rowe BR, Lawson N, et al. Comparison of the effects of an angiotensin converting enzyme inhibitor and a calcium antagonist in hypertensive, macroproteinuric diabetic patients: a randomised double-blind study. J Hum Hypertens 1993; 7: 333–339.PubMedGoogle Scholar
  23. 23.
    Nielsen FS, Rossing P, Gall MA, et al. Impact of lisinopril and atenolol on kidney function in hypertensive NIDDM subjects with diabetic nephropathy. Diabetes 1994; 43: 1108–1113.PubMedCrossRefGoogle Scholar
  24. 24.
    Ravid M, Savin H, Jutrin I, et al. Long-term effect of ACE inhibition on development of nephropathy in diabetes mellitus type II. Kidney Int 1994; 45: Suppl. 45: S161–S164.Google Scholar
  25. 25.
    Rossing P, Hommel E, Smidt UM, et al. Reduction in albuminuria predicts diminished progression in diabetic nephropathy. Kidney Int 1994; 45: Suppl. 45: S145–S149.Google Scholar
  26. 26.
    Sano T, Kawamura T, Matsumae H, et al. Effects of long-term enalapril treatment on persistent micro-albuminuria in well-controlled hypertensive and normotensive NIDDM patients. Diabetes Care 1994; 17: 420–424.PubMedCrossRefGoogle Scholar
  27. 27.
    Viberti G, Mogensen CE, Groop LC, et al. Effect of captopril on progression to clinical proteinuria in patients with insulin-dependent diabetes mellitus and microalbuminuria. European Microalbuminuria Captopril Study Group. JAMA 1994; 271: 275–279.PubMedCrossRefGoogle Scholar
  28. 28.
    Zanetti-Elshater F, Pingitore R, Beretta-Piccoli C, et al. Calcium antagonists for treatment of diabetes-associated hypertension. Metabolic and renal effects of amlodipine. Am J Hypertens 1994; 7: 36–45.PubMedGoogle Scholar
  29. 29.
    Fogari R, Zoppi A, Pasotti C, et al. Comparative effects of ramipril and nitrendipine on albuminuria in hypertensive patients with non-insulin-dependent diabetes mellitus and impaired renal function. J Hum Hypertension 1995; 9: 131–135.Google Scholar
  30. 30.
    Bakris GL, Copley JB, Vicknair N, et al. Effects of nondihydropyridine calcium antagonists on progression of nephropathy resulting from noninsulin dependent diabetes: A five year follow up study. J Am Soc Nephrol 1996; in press.Google Scholar
  31. 31.
    Mogensen CE. Progression of nephropathy in long-term diabetics with proteinuria and effect of initial anti-hypertensive treatment. Scand J Clin Lab Invest 1976; 36: 383–388.PubMedCrossRefGoogle Scholar
  32. 32.
    Parving HH, Andersen AR, Smidt UM, et al. Reduced albuminuria during early and aggressive antihypertensive treatment of insulin-dependent diabetic patients with diabetic nephropathy. Diabetes Care 1981; 4: 459–463.PubMedCrossRefGoogle Scholar
  33. 33.
    Parving HH, Andersen AR, Smidt UM, et al. Early aggressive antihypertensive treatment reduces rate of decline in kidney funtion in diabetic nephropathy. Lancet 1983; i: 1175–1178.CrossRefGoogle Scholar
  34. 34.
    Gambaro G, Morbiato F, Cicerello E, et al. Captopril in the treatment of hypertension in type I and type II diabetic patients. J Hypertension 1985; 3: Suppl. 2: S149–S151.CrossRefGoogle Scholar
  35. 35.
    Parving HH, Andersen AR, Hommel E, et al. Effects of long-term antihypertensive treatment on kidney function in diabetic nephropathy. Hypertension 1985; 7: II 114–117.Google Scholar
  36. 36.
    D’Angelo A, Sartori L, Gambaro G, et al. Captopril in the treatment of hypertension in type I and type II diabetics. Postgrad Med J 1986; 62: Suppl. 1: 69–72.PubMedGoogle Scholar
  37. 37.
    Christensen CK and Mogensen CE. Antihypertensive treatment: long-term reversal of progression of albuminuria in incipient diabetic nephropathy. A longitudinal study of renal function. J Diabetic Compl 1987; 1:45–52.CrossRefGoogle Scholar
  38. 38.
    Parving HH, Andersen AR, Smidt UM, et al. Effect of antihypertensive treatment on kidney function in diabetic nephropathy. BMJ 1987; 294: 1443–1447.PubMedCrossRefGoogle Scholar
  39. 39.
    Parving HH, Hommel E and Smidt UM. Protection of kidney function and decrease in albuminuria by captopril in insulin dependent diabetics with nephropathy. BMJ 1988; 297: 1086–1091.PubMedCrossRefGoogle Scholar
  40. 40.
    Stornello M, Valvo E, Puglia N, et al. Angiotensin converting enzyme inhibition with a low dose of enalapril in normotensive diabetics with persistent proteinuria. J Hypertension 1988; 6: Suppl. 4: S464–S466.Google Scholar
  41. 41.
    Valvo E, Bedogna V, Casagrande P, et al. Effects of captopril on systemic and renal haemodynamics in patients with diabetic nephropathy and renal insufficiency (Abstract). Postgrad Med J 1988; 64: Suppl. 3: 89–92.Google Scholar
  42. 42.
    Valvo E, Berdogna V, Casagrande P, et al. Captopril in patients with type II diabetes and renal insufficiency: systemic and renal hemodymamic alterations. Am J Med 1988; 85: 344–348.PubMedCrossRefGoogle Scholar
  43. 43.
    Elving LD, de Nobel E, van Lier HJJ, et al. A comparison of the hypotensive effects of captopril and atenolol in the treatment of hypertension in diabetic patients. J Clin Pharm 1989; 29: 316–320.CrossRefGoogle Scholar
  44. 44.
    Parving HH, Hommel E, Djamkjær Nielsen M, et al. Effect of captopril on blood pressure and kidney function in normotensive insulin dependent diabetics with nephropathy. BMJ 1989; 229: 553–556.Google Scholar
  45. 45.
    Stornello M, Valvo EV and Scapellato L. Hemodynamic, 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: 851–855.PubMedCrossRefGoogle Scholar
  46. 46.
    Bakris GL. Effects of diltiazem or lisinopril on massive proteinuria associated with diabetes mellitus. Ann Int Med 1990; 112: 707–708.PubMedCrossRefGoogle Scholar
  47. 47.
    Grönhagen-Riske C, Honkanen E, Metsärinne K, et al. ACE-inhibition versus conventional antihypertensive treatment (b-blockade) in diabetic nephropathy. Am J Hypertension 1990; 3: 67A.Google Scholar
  48. 48.
    Morelli E, Loon N, Meyer T, et al. Effects of converting-enzyme inhibition on barrier function in diabetic glomerulopathy. Diabetes 1990; 39: 76–82.PubMedCrossRefGoogle Scholar
  49. 49.
    Romero R, Salinas I, Lucas A, et al. Comparative effects of captopril versus nifedipine on proteinuria and renal function of type 2 diabetic patients. Diabetes Res Clin Pract 1990; 17: 191–198.CrossRefGoogle Scholar
  50. 50.
    Bochicchio T, Ron O, Sandoval G, et al. Effect of captopril on proteinuria and renal hemodynamcs in hypertensive type-II diabetic patients with nephropathy. Hypertension 1991; 17: 422.Google Scholar
  51. 51.
    Brusztyn M, Kobrin I, Fidel J, et al. Improved kidney function with cilazapril in hypertensive type II diabetics with chronic renal failure. J Cardiovasc Pharmacol 1991; 18: 337–341.CrossRefGoogle Scholar
  52. 52.
    Holdaas H, Hartmann A, Lien MG, et al. Contrasting effects of lisinopril and nifedipine on albuminuria and tubular transport functions in insulin dependent diabetics with nephropathy. J Intern Med 1991; 229: 163–170.PubMedCrossRefGoogle Scholar
  53. 53.
    Inserra F, Daccordi HA, Martello MA, et al. Enalapril effects on hypertensive patients with proteinuria and impaired glucose metabolism. Diabetes 1991; 40: 506A.Google Scholar
  54. 54.
    Martello MA, Daccordi HA, Ferder LF, et al. Enalapril versus nifedipine in diabetic patients with hypertension and proteinuria. Diabetes 1991; 40: 506A.Google Scholar
  55. 55.
    O’Donnell HJ, Rowe BR, Lawson N, et al. Lisinopril versus nifedipine in the treatment of hypertensive macroproteinuric diabetics. Diabetes 1991; Suppl. 2: A38.Google Scholar
  56. 56.
    Stornello M, Valvo EV and Scapellato L. Comparative effects of enalapril, atenolol and chlorthalidone on blood pressure and kidney function of diabetic patients affected by arterial hypertension and persistent proteinuria. Nephron 1991; 58: 52–57.PubMedCrossRefGoogle Scholar
  57. 57.
    Bakris GL, Barnhill BW and Sadler R. Treatment of arterial hypertension in diabetic humans: importance of therapeutic selection. Kidney Int 1992; 41: 912–919.PubMedCrossRefGoogle Scholar
  58. 58.
    Bauer JH, Reams GP, Hewett J, et al. A randomized, double-blind, placebo-controlled trial to evaluate the effect of enalapril in patients with clinical diabetic nephropathy. Am J Kidney Dis 1992; 20: 443–457.PubMedGoogle Scholar
  59. 59.
    Björck S, Mulec H, Johnsen SA, et al. Renal protective effect of enalapril in diabetic nephropathy. BMJ 1992; 304: 339–343.PubMedCrossRefGoogle Scholar
  60. 60.
    Bochicchio T, Ron O, Sandoval G, et al. Antiproteinuric effect of captopril is associaged with restoration of renal functional reserve (RFR) in NIDDM patients with nephropathy. J Hypertension 1992; 10: Suppl. 4: S134.Google Scholar
  61. 61.
    Ferder L, Daccordi H, Martello M, et al. Angiotensin converting enzyme inhibitors versus calcium antagonists in the treatment of diabetic hypertensive patients. Hypertension 1992; 19: Suppl. II: II–237–II–242.Google Scholar
  62. 62.
    Stornello M, Valvo EV and Scapellato L. Persistent albuminuria in normotensive non-insulin-dependent (type II) diabetic patients: comparative effects of angiotensin-converting enzyme inhibitors and beta-adrenoceptor blockers. Clin Sci 1992; 82: 19–23.PubMedGoogle Scholar
  63. 63.
    Slataper R, Vicknair N, Sadler R, et al. Comparative effects of different antihypertensive treatments on progression of diabetic renal disease. Arch Intern Med 1993; 153: 973–980.PubMedCrossRefGoogle Scholar
  64. 64.
    Kasiske BL, Kalil RS, Ma JZ, et al. Effect of antihypertensive therapy on the kidney in patients with diabetes: a meta-regression analysis. Ann Intern Med 1993; 118: 129–138.PubMedCrossRefGoogle Scholar
  65. 65.
    Mogensen CE, Maurer SM and Kjellstrand CM. »Diabetic nephropathy.« In Diseases of the Kidney, Schrier RW, Gottschalk CW, ed. Boston: Little Brown, 1988; pp 2395–2437.Google Scholar
  66. 66.
    Keane WF, Anderson S, Aurell M, et al. Angiotensin converting enzyme inhibitors and progressive renal insufficienty. Ann Int Med 1989; 111: 503–516.PubMedCrossRefGoogle Scholar
  67. 67.
    Steinhausen M, Endlich K and Wiegman DL. Glomerular blood flow. Kidney Int 1990; 38: 769–784.PubMedCrossRefGoogle Scholar
  68. 68.
    Ruilope LM and Alcazar JM. Renal effects of calcium entry blockers. Cardiovasc Drugs Ther 1990; 4: 979–982.PubMedCrossRefGoogle Scholar
  69. 69.
    Bakris GL. Renal effects of calcium antagonists in diabetes mellitus. An overview of studies in animal models and in humans. Am J Hypertension 1991; 4: 489S–493S.CrossRefGoogle Scholar
  70. 70.
    ter Wee PM, De Micheli AG and Epstein M. Effects of calcium antagonists an renal hemodynamics and progression of nondiabetic chronic renal disease. Arch Intern Med 1994; 154: 1185–1202.PubMedCrossRefGoogle Scholar
  71. 71.
    De Marie BK and Bakris GL. Effects of different classes of calcium antagonists on proteinuria in diabetic subjects. Arch Intern Med 1990; 113: 987–988.CrossRefGoogle Scholar
  72. 72.
    Muiesan G, Agabiti-Rosei E, Castellano M, et al. Antihypertensive and humoral effects of verapamil and nifedipine in essential hypertension. J Cardiovasc Pharm 1982; 4: Suppl. 3: S325–S329.Google Scholar
  73. 73.
    Weidmann P, Gerber A and Laederach K. Calcium antagonist in the treatment of hypertension: a critical overview. Adv Nephrol Necker Hosp 1985; 14P: 197–232.Google Scholar
  74. 74.
    Lindqvist M, Kahan T, Melcher A, et al. Acute and chronic calcium antagonist treatment elevates sympathetic activity in primary hypertension. Hypertension 1994; 24: 287–296.PubMedCrossRefGoogle Scholar
  75. 75.
    Meyer TW, Morelli E, Loon N, et al. Converting enzyme inhibition and glomerular size selectivity in diabetic nephropathy. J Am Soc Nephrol 1990; 1: Suppl. 2: 564–568.Google Scholar
  76. 76.
    Remuzzi A, Puntoieri S, Battaglia C, et al. Angiotensin converting enzyme inhibition ameliorates glomerula filtration of macromolecules and water and lessens glomerular injury in the rat. J Clin Invest 1990; 85: 541–549.PubMedCentralPubMedCrossRefGoogle Scholar
  77. 77.
    Epstein M. Calcium antagonists and the kidney: implications for renal protection. Kidney Int 1992; 41: Suppl. 36: S66–S72.Google Scholar
  78. 78.
    Christensen CK, Pedersen OL and Mikkelsen E. Renal effects of acute calcium blockade with nifedipine in hypertensive patients receiving beta-adrenergic-blocking drugs. Clin Pharmacol Ther 1982; 32: 572–576.PubMedCrossRefGoogle Scholar
  79. 79.
    Holdaas H, Hartmann A, Lien MG, et al. Contrasting effects of lisinopril and nifedipine on albuminuria and tubular transport functions in insulin dependent diabetics with nephropathy. J Int Med 1991; 229: 163–170.CrossRefGoogle Scholar
  80. 80.
    Bennet PH, Haffner S, Kasiske BL, et al. Screening and management of microalbuminuria in patients with diabetes mellitus: recommendations to the scientific advisory board of the national kidney foundation from an ad hoc committee of the council on diabetes mellitus of the national kidney foundation. Am J Kidney Dis 1995; 25: 107–112.CrossRefGoogle Scholar
  81. 81.
    Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effects of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients with incipient nephropathy. Ann Intern Med 1993; 118: 577–581.PubMedCrossRefGoogle Scholar
  82. 82.
    Lebowitz HE, Wiegman TB, Cnaan A, et al. Renal protecive effects of enalapril in hypertensive NIDDM: role of baseline albuminuria. Kidney Int 1994; 45: Suppl. 45: 150–155.Google Scholar
  83. 83.
    Hebert LA, Bain RP, Verme D, et al. Remission of nephrotic range proteinuria in type I diabetes. Kidney Int 1994; 46: 1688–1693.PubMedCrossRefGoogle Scholar
  84. 84.
    Remuzzi G and Bertani T. Is glomerulosclerosis a consequence of altered glomerular permeability to macromolecules? Kidney Int 1990; 38: 384–394.PubMedCrossRefGoogle Scholar
  85. 85.
    Perico N, Amuchastegui CS, Malanchini B, et al. Angiotensin-converting enzyme inhibition and calcium channel blockade both normalize early hyperfiltration in experimental diabetes, but only the former prevents late structural damage. Exp Nephrol 1994; 2: 220–228.PubMedGoogle Scholar
  86. 86.
    Apperloo AJ, de Zeeuw D and de Jong PE. Short-term antiproteinuric response to antihypertensive treatment predicts long-term GFR-decline in patients with non-diabetic renal disease. Kidney Int 1994; 45: Suppl. 45: S174–S178.Google Scholar
  87. 87.
    Fioretto P, Frigato F, Velussi M, et al. Effects of angiotensin converting enzyme inhibitors and calcium antagonists on atrial natriuretic peptide release and action and on albumin excretion rate in hypertensive insulin-dependent diabetic patients. Am J Hypertens 1992; 5: 837–846.PubMedGoogle Scholar
  88. 88.
    Manto A, Cotroneo P, Marra G, et al. Effect of intensive treatment on diabetic nephropathy in patients with type I diabetes. Kidney Int 1995; 47: 231–235.PubMedCrossRefGoogle Scholar
  89. 89.
    Little Inc AD, Economic analysis of captopril in slowing the rate of progression to end-stage renal disease in diabetic patients. Final Report to BMS, 1994.Google Scholar
  90. 90.
    Szucs T, Ritz E and Standi E. Die Wirtschaftlichkeit von Captopril. Münch Med Wschr 1994; 136: 581–585.Google Scholar

Copyright information

© Springer Science+Business Media New York 1996

Authors and Affiliations

  • L. Böhlen
    • 1
  • M. Schneider
    • 1
  • M. De Courten
    • 1
  • P. Weidmann
    • 1
  1. 1.Medizinische UniversitätspoliklinikInselspital BernSwitzerland

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