Why the study?
It was unknown whether pharmacological treatment with an ACEi could delay the onset of albuminuria, hypertension, or diabetes in a remote-living Australian Aboriginal group at high risk for chronic disease who were free of those conditions.
Does perindopril arginine prevent new-onset albuminuria, hypertension, diabetes, or cardiovascular events in high-risk remote-living Australian Aboriginal adults?
Does perindopril arginine prevent new-onset albuminuria, hypertension, diabetes, or cardiovascular events in high-risk remote-living Australian Aboriginal adults?
Perindopril arginine may delay the development of diabetes and hypertension in a high-risk remote Australian Aboriginal population, though findings are limited by small sample size and high dropout rates.
Answers are grounded in this paper and cite their sources.
May support perindopril arginine to prevent diabetes or hypertension; extends evidence to this population but requires larger trials.
INTRODUCTION: We conducted a double-blind randomised controlled trial in a remote-living Australian Aboriginal group at high risk for chronic disease to assess whether pharmacological treatment with angiotensin converting enzyme inhibitor (ACEi) could delay the onset of albuminuria, hypertension or diabetes in people currently free of those conditions. METHODS: Eligibility criteria in 2008 were age ≥18yr, blood pressure ≤140/90 mm/Hg, urinary albumin creatinine ratio (ACR) < 3.4 mg/mmol, normal levels of glycosylated haemoglobin, and, in females, infertility. A 2011 amendment allowed enrolment of fertile females using long-term contraception. "Treatment" was the ACEi perindopril arginine, or placebo, and participant events were ACR ≥3.4 mg/mmol and/or blood pressure >140/90 mm Hg and/or haemoglobin A1c >6.5%, and/or cardiovascular events. Results were analysed in 125 randomised participants who commenced treatment. RESULTS: Recruitment was low, especially of women, and dropout rates high: there were finally 60 and 65 people in the ACEi and placebo groups respectively. In females, there were no events among 10 in the ACEi group, versus 5 events among 17 in the placebo group, and longitudinal ACR, HbA1c and blood pressure levels supported probable benefit of ACEi. There was no benefit of ACEi in males, but a probable benefit on diabetes/hypertension events. With the genders combined, there was probable reduction of diabetes (zero vs 4 events, p = 0.068), and of diabetes or hypertension (zero vs 5 events, p = 0.037). DISCUSSION: In this high-risk population, ACEi probably delays development of albuminuria, diabetes and hypertension in females, and of non-ACR events overall. Repeat investigation with a larger sample size is warranted.
No takes yet. Share an insight, caveat, or question.
Hoy et al. (2019) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: