Why the study?
Does enalapril reduce proteinuria compared to losartan in patients with type 2 diabetic nephropathy?
Does enalapril reduce proteinuria compared to losartan in patients with type 2 diabetic nephropathy?
In a small cohort of patients with type 2 diabetic nephropathy, maximum dose enalapril (40 mg) showed a significant reduction in protein creatinine ratio compared to maximum dose losartan (200 mg), though neither drug sufficiently reduced overall proteinuria or blood pressure.
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Maximum-dose enalapril reduces proteinuria more than losartan in diabetic nephropathy; extends RCT comparisons but neither suffices for BP or proteinuria control.
A prospective, open label, parallel group and randomized study was conducted to see the effect of enalapril and losartan on proteinuria in type 2 diabetic nephropathy patients. 18 patients (proteinuria 2 0.5 gm/day and serum creatinine <3 mg/dL) were selected and then randomly grouped to receive enalapril (5-40 mg/day, n=10) and losartan (25-200 mg/day, n=8) in increasing dose for 16 weeks. No statistically significant alteration in the urinary total protein, protein creatinine ratio, serum creatinine, estimated glomerular filtration rate, serum potassium and blood pressure was observed in any group. After attaining maximum dose (40 mg and 200 mg respectively), enalapril group showed significant (p < 0.04) reduction of protein creatinine ratio in comparison to losartan group. It may be concluded that 40 mg enalapril or 200 mg losartan are not sufficient to reduce proteinuria and blood pressure significantly in type 2 proteinuric diabetics with renal dysfunction although both drugs were well tolerated at high doses.
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Hoque et al. (2009) studied this question.
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