In hypertensive patients with type 2 diabetes, follow-up blood pressure reduction independently predicted the risk for microalbuminuria (P<0.001), and ACE inhibitor therapy further reduced this risk.
RCT (n=1,204)
Randomized
Does trandolapril, verapamil SR, or their combination prevent persistent microalbuminuria in hypertensive patients with type 2 diabetes and normoalbuminuria?
In hypertensive patients with type 2 diabetes and normoalbuminuria, both BP reduction and ACE inhibitor therapy independently prevent microalbuminuria, with ACE inhibitors being particularly effective when BP is poorly controlled.
valor p: p=<0.001
For assessment of the independent renoprotective effect of BP control and angiotensin-converting enzyme inhibitor (ACEi) therapy, the relationships of baseline BP, BP reduction, and follow-up BP with the incidence of persistent microalbuminuria were evaluated in 1204 hypertensive patients who had type 2 diabetes and normoalbuminuria and were included in the BErgamo Nephrologic Diabetic Complications Trial (BENEDICT) study and were randomly assigned to 3.6 yr of treatment with the ACEi trandolapril (2 mg/d), the nondihydropyridine calcium channel blocker (ndCCB) verapamil SR (240 mg/d), their fixed combination Veratran (trandolapril 2 mg/d plus verapamil SR 180 mg/d), or placebo, plus other antihypertensive medications targeted at systolic/diastolic BP <130/80 mmHg. Follow-up (from month 3 to study end) systolic, diastolic, mean, and pulse BP and their reductions versus baseline--but not baseline BP--independently predicted (P < 0.001) the risk for microalbuminuria. In patients with follow-up BP above medians, ACEi significantly reduced the risk for microalbuminuria to levels that were observed among patients with BP below medians, regardless of ACEi treatment. The same trend was observed among patients with BP reductions below medians. ndCCB therapy did not independently affect microalbuminuria. Patients who were on Veratran had lower BP and less frequently received diuretics, beta blockers, or dihydropyridine dCCB. In hypertensive, normoalbuminuric patients with type 2 diabetes, BP reduction and ACEi therapy both independently may prevent microalbuminuria. ACEi therapy is particularly effective when BP is poorly controlled, whereas ndCCB therapy is ineffective at any level of achieved BP. As compared with trandolapril, Veratran may help with achievement of target BP with less need for concomitant antihypertensive medications.
Ruggenenti et al. (Fri,) conducted a rct in Hypertension with type 2 diabetes and normoalbuminuria (n=1,204). Trandolapril, verapamil SR, or their fixed combination (Veratran) vs. Placebo was evaluated on Incidence of persistent microalbuminuria (p=<0.001). In hypertensive patients with type 2 diabetes, follow-up blood pressure reduction independently predicted the risk for microalbuminuria (P<0.001), and ACE inhibitor therapy further reduced this risk.