Long-term treatment with captopril and a diuretic significantly lowered the rate of decline in glomerular filtration rate (5.8 vs 10.0 ml/year, p<0.01) in diabetics with nephropathy.
Observational (n=31)
No
Does captopril combined with diuretics improve kidney function and reduce albuminuria in hypertensive insulin-dependent diabetics with nephropathy?
Captopril combined with diuretics significantly reduces the rate of decline in glomerular filtration rate and decreases albuminuria in hypertensive insulin-dependent diabetics with nephropathy.
Absolute Event Rate: 5.8% vs 10%
p-value: p=<0.01
STUDY OBJECTIVE: To assess whether long term inhibition of angiotensin converting enzyme with captopril and frusemide or bendrofluazide protects kidney function in diabetic nephropathy. DESIGN: Non-randomised controlled before-after trial of matched hypertensive insulin dependent diabetics with nephropathy treated with captopril and frusemide or bendrofluazide. SETTING: Outpatient diabetic clinic in tertiary referral centre. PATIENTS: Treatment group of 18 hypertensive insulin dependent diabetics with nephropathy (mean age 33), who had not been treated previously. Control group of 13 patients (mean age 32) fulfilling the same entry criteria from a prospective study. INTERVENTIONS: Treatment group was given daily captopril 37.5-100.0 mg and frusemide (mean) 98 mg (10 patients) or bendrofluazide (mean) 4 mg (seven). Treatment was continued for about two and a half years. Controls were not treated. END POINT: Measurement of arterial blood pressure, albuminuria, and glomerular filtration. MEASUREMENTS AND MAIN RESULTS: Baseline values were identical in treated and untreated groups respectively: mean blood pressure 146/93 (SE 3/1) mm Hg v 137/95 (2/1) mm Hg; geometric mean albuminuria 982 (antilog SE 1.2) micrograms/min v 936 (1.2) micrograms/min; and mean glomerular filtration rate 98 (SE 5) ml/min/1.73 m2 v 96 (6) ml/min/1.73 m2. Mean arterial blood pressure fell by 8.7 (1.3) mm Hg with captopril and rose by 6.6 (1.5) mm Hg in controls, (p less than 0.001); Albumin excretion decreased to 390 (1.1) micrograms/min with captopril and rose to 1367 (1.3) micrograms/min in controls (p less than 0.001). The rate of decrease in glomerular filtration rate was lower with captopril (5.8 (0.7) ml/year v 10.0 (1.3) ml/year) (p less than 0.01). Rate of fall in glomerular filtration rate and mean arterial blood pressure were significantly correlated (n = 31, r = 0.37, p less than 0.05). CONCLUSIONS: Captopril is a valuable new drug for treating hypertension in insulin dependent diabetics with nephropathy.
Parving et al. (1988) conducted an observational in Hypertensive insulin dependent diabetics with nephropathy (n=31). Captopril and frusemide or bendrofluazide vs. No treatment was evaluated on Rate of decrease in glomerular filtration rate (ml/year) (p=<0.01). Long-term treatment with captopril and a diuretic significantly lowered the rate of decline in glomerular filtration rate (5.8 vs 10.0 ml/year, p<0.01) in diabetics with nephropathy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: