Indapamide is as effective as captopril in the control of microalbuminuria in diabetes
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L M Molyneaux1, K A Willey, D K Yue
1Diabetes Centre, Royal Prince Alfred Hospital, New South Wales, Australia.
Abstract:
Microalbuminuria is a predictor of overt diabetic nephropathy and macrovascular disease. Thirty-one diabetic patients with persistent urinary albumin excretion rate (AER) of 20-200 mu g min-1 were randomised to receive indapamide 2.5 mg or captopril 37.5 mg daily for 12 weeks. After a 4-week washout, patients received the alternate agent for 12 weeks. Resting blood pressure (BP), AER, cholesterol, triglycerides, and HbA1c were measured at baseline, after 6 and 12 weeks of each treatment, and after a 4-week washout period following each treatment arm. Results from patients who completed at least one treatment arm were analysed by repeated-measures analysis of variance (ANOVA). AER (median value and interquartile range) decreased significantly from baseline after treatment with indapamide and captopril [60(27-106) vs. 40(14-112) and 33(17-100); p < 0.005], but there was no difference between the effects of the two agents. Mean systolic BP (SBP) was also significantly reduced with treatment, and no difference was noted between the effects of the two agents. No correlation between changes in AER and SBP was noted with either agent. Diastolic blood pressure (DBP), cholesterol, triglycerides, and HbA1c did not change during the study. These results suggest that indapamide is an effective alternative to angiotensin-converting enzyme (ACE) inhibitors in the treatment of diabetic patients with microalbuminuria.
Insights
Indapamide and captopril effectively reduce albuminuria in diabetic patients. Both treatments significantly lowered blood pressure, with no significant difference between the two drugs for microalbuminuria or blood pressure control.
Area of Science:
- Nephrology
- Endocrinology
- Pharmacology
Background:
- Microalbuminuria predicts diabetic nephropathy and macrovascular complications.
- Early detection and management of microalbuminuria are crucial in diabetes care.
Purpose of the Study:
- To compare the efficacy of indapamide and captopril in reducing albuminuria in diabetic patients.
- To assess the impact of these agents on blood pressure and metabolic parameters.
Main Methods:
- A randomized, crossover study involving 31 diabetic patients with persistent microalbuminuria.
- Patients received indapamide 2.5 mg and captopril 37.5 mg daily for 12 weeks each, with a 4-week washout period.
- Measurements included albumin excretion rate (AER), blood pressure, cholesterol, triglycerides, and HbA1c.
Main Results:
- Both indapamide and captopril significantly reduced AER from baseline (p < 0.005).
- No significant difference was observed between indapamide and captopril in reducing AER or systolic blood pressure.
- No significant changes were noted in diastolic blood pressure, cholesterol, triglycerides, or HbA1c.
Conclusions:
- Indapamide is an effective alternative to angiotensin-converting enzyme (ACE) inhibitors for treating microalbuminuria in diabetic patients.
- Both indapamide and captopril demonstrate comparable efficacy in managing microalbuminuria and reducing blood pressure in this population.