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Reduction of ACE activity is insufficient to decrease microalbuminuria in normotensive patients with type 1 diabetes.

M Bojestig1, B E Karlberg, T Lindström

  • 1Department of Medicine and Care, University Hospital of Linköping, Sweden.

Diabetes Care
|May 12, 2001
PubMed
Summary

Ramipril did not reduce urinary albumin excretion in normotensive patients with type 1 diabetes. This study questions the clinical use of ACE inhibitors in this patient group without demonstrated blood pressure reduction.

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Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Type 1 diabetes is associated with microalbuminuria, a risk factor for cardiovascular and renal disease.
  • Angiotensin-converting enzyme (ACE) inhibitors are often used to manage microalbuminuria.
  • The efficacy of ACE inhibitors in normotensive diabetic patients requires further investigation.

Purpose of the Study:

  • To evaluate the effect of ramipril on urinary albumin excretion rate (UAER) in normotensive patients with type 1 diabetes.
  • To assess the impact of ramipril on blood pressure and the renin-angiotensin system in this population.

Main Methods:

  • A double-blind, placebo-controlled study involving 55 patients with type 1 diabetes.
  • Patients received ramipril (1.25 mg or 5.0 mg daily) or placebo for 2 years.

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  • Measurements included UAER, ACE activity, plasma renin activity (PRA), and 24-hour ambulatory blood pressure.

    • Main Results:

    • Ramipril significantly reduced ACE activity and increased PRA compared to placebo.
    • Neither dose of ramipril affected ambulatory or clinic blood pressure.
    • No significant differences in UAER were observed between ramipril and placebo groups at 1 or 2 years.

    Conclusions:

    • Ramipril treatment did not reduce microalbuminuria or affect blood pressure in normotensive type 1 diabetes patients.
    • The clinical utility of ACE inhibitors in this specific patient group, without concomitant blood pressure reduction, is questionable.