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Study of ACEI versus ARB in managing hypertensive overt diabetic nephropathy: long-term analysis
Savas Ozturk1, Fuat Sar, Olcay Bengi-Bozkurt
1Department of Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey. savasozturkdr@yahoo.com
Insights
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) showed similar outcomes in patients with diabetic nephropathy. These drugs offer renoprotective effects even with uncontrolled hypertension.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- No prior studies directly compared ACEI and ARB in hypertensive patients with overt diabetic nephropathy (DNP).
- This study aimed to analyze outcomes in hypertensive patients with type 2 DNP using either ACEIs or ARBs exclusively.
Purpose of the Study:
- To compare the clinical outcomes of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in patients with overt type 2 diabetic nephropathy and hypertension.
- To evaluate the renoprotective effects of ACEIs versus ARBs in this patient population.
Main Methods:
- Included 100 hypertensive patients with estimated creatinine clearance <90 ml/min and overt type 2 DNP.
- Patients were divided into two groups: one receiving ACEIs and the other receiving ARBs.
- Follow-up averaged 24.6 months, monitoring renal function, proteinuria, and blood pressure.
Main Results:
- Baseline characteristics, renal function, and proteinuria remained similar between ACEI and ARB groups throughout follow-up.
- Blood pressure control was comparable in both groups.
- While creatinine doubling time was shorter in the ARB group, the difference was not statistically significant. Dialysis initiation was linked to baseline serum creatinine and proteinuria levels.
Conclusions:
- ACEIs and ARBs demonstrate comparable outcomes in managing overt diabetic nephropathy.
- Both drug classes exhibit renoprotective effects, even when hypertension is not fully controlled.
Background:
There is, to our knowledge, no study that has directly compared angiotensin-converting enzyme inhibitor (ACEI) with angiotensin receptor blocker (ARB) in hypertensive patients with overt diabetic nephropathy (DNP). We tried to analyze the outcomes of hypertensive patients with overt type 2 DNP who used only ACEIs or ARBs.
Methods:
The patients who had an estimated creatinine clearance <90 ml/min and hypertension or had been using antihypertensive drug(s) at presentation were included in the study. The patients were classified as ACEI group and ARB group.
Results:
A total of 100 patients (55 men and 45 women, mean age 61.8 +/- 9.16 years) were included in the study. Mean duration of follow-up was 24.6 +/- 14.1 months. Baseline demographics, biochemical analyses and blood pressures were similar. Renal functions and proteinuria of both groups did not show any significant changes during follow-up. Blood pressure courses were also similar. Although the mean doubling time of creatinine in the ARB group was shorter than the ACEI group, it was not statistically significant. During the follow-up period, 4 patients died (2 in the ACEI group, 2 in the ARB group) and 10 patients were started on dialysis (7 in the ACEI group, 3 in the ARB group). Serum creatinine and the amount of proteinuria were the baseline parameters which were related to the initiation of dialysis.
Conclusion:
ACEIs and ARBs have similar outcomes in overt DNP. Their renoprotective effects can be observed in spite of uncontrolled hypertension.
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