Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2...

Area of Science:

• Nephrology
• Endocrinology
• Cardiovascular Medicine

Background:

• Diabetic nephropathy is a major complication of type 2 diabetes.
• The independent effects of irbesartan and amlodipine on slowing diabetic nephropathy progression are not well understood.

Purpose of the Study:

• To investigate whether irbesartan or amlodipine slows the progression of nephropathy in patients with type 2 diabetes independently of their blood pressure-lowering effects.

Main Methods:

• A randomized trial involving 1715 hypertensive patients with type 2 diabetes and nephropathy.
• Patients were assigned to irbesartan (300 mg daily), amlodipine (10 mg daily), or placebo, with a target blood pressure of ≤135/85 mm Hg.
• Primary composite end point: doubling of serum creatinine, end-stage renal disease, or death from any cause.

Main Results:

• Irbesartan reduced the risk of the primary composite end point by 20% versus placebo and 23% versus amlodipine.
• The risk of doubling serum creatinine concentration was significantly lower with irbesartan compared to placebo and amlodipine.
• Irbesartan slowed the increase in serum creatinine concentration by 24% versus placebo and 21% versus amlodipine, independent of achieved blood pressure levels.

Conclusions:

• Irbesartan effectively protects against the progression of diabetic nephropathy in type 2 diabetes.
• The renoprotective benefits of irbesartan are independent of its blood pressure-lowering effects.