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August 1, 2003Diabetes CareOpen Access

Renoprotective Effects of Adding Angiotensin II Receptor Blocker to Maximal Recommended Doses of ACE Inhibitor in Diabetic Nephropathy

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Why the study?

Does adding candesartan 16 mg daily to maximal recommended doses of ACE inhibitor reduce albuminuria in patients with type 2 diabetes and nephropathy?

Population

20 patients (17 men and 3 women) with type 2 diabetes along with hypertension and nephropathy

Comparison

Candesartan 16 mg daily added to existing… vs Placebo added to existing treatment with…

Design

RCT, randomized, two-period, crossover, double-blind

Follow-up

8 weeks per treatment period

Authors

KRKasper RossingHeart Failure & TransplantPJPeter Karl JacobsenElectrophysiologyLPLotte PietraszekSteno Diabetes Centers

Discussion

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Implication

Supports dual RAS blockade for short-term renoprotection in type 2 diabetic nephropathy; extends ACEI monotherapy data on albuminuria reduction.

Structured PICO

Does adding candesartan 16 mg daily to maximal recommended doses of ACE inhibitor reduce albuminuria in patients with type 2 diabetes and nephropathy?

P
Population
20 patients (17 men and 3 women) with type 2 diabetes along with hypertension and nephropathy
I
Intervention
Candesartan 16 mg daily added to existing treatment with lisinopril/enalapril 40 mg daily or captopril 150 mg daily for 8 weeks
C
Comparator
Placebo added to existing treatment with lisinopril/enalapril 40 mg daily or captopril 150 mg daily for 8 weeks
O
Outcome
Short-term changes in albuminuria evaluated in three 24-h urinary collections by turbidimetry at the end of 8 weekssurrogate

Adding candesartan to maximal recommended doses of ACE inhibitors provides superior short-term renoprotection by reducing albuminuria in patients with type 2 diabetic nephropathy, independent of blood pressure changes.

Cite This Study

Rossing et al. (2003) studied this question.

synapsesocial.com/papers/6a6fde3431a3df8243282c33https://doi.org/10.2337/diacare.26.8.2268
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Randomized controlled crossover study of the effect on proteinuria and blood pressure of adding an angiotensin II receptor antagonist to an angiotensin converting enzyme inhibitor in normotensive patients with chronic renal disease and proteinuria2002 · 85 citations
  2. 2Renoprotective Effect of the Angiotensin-Receptor Antagonist Irbesartan in Patients with Nephropathy Due to Type 2 Diabetes2001 · 6,044 citations
  3. 3Safety of the combination of valsartan and benazepril in patients with chronic renal disease2000 · 180 citations
  4. 4Angiotensin II stimulates expression of the chemokine RANTES in rat glomerular endothelial cells. Role of the angiotensin type 2 receptor.1997 · 253 citations
  5. 5A Simple Method for the Determination of Glomerular Filtration Rate1972 · 897 citations