Skip to main content
SpringerLink
Log in

Stabilization and regression of albuminuria in Chinese patients with type 2 diabetes: A one-year randomized study of valsartan versus enalapril

  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

This study was designed to compare the short-term (1-y) tolerability and antiproteinuric efficacy of enalapril and valsartan in patients with type 2 diabetes. Fortytwo patients with normal renal function or early-stage nephropathy were recruited in Hong Kong and randomized to valsartan 80 mg/day or enalapril 5 mg/day; the doses were increased to 160 mg and 10 mg daily, respectively, as tolerated. Early-morning urine was analyzed for albumin and creatinine and 24-hour urinary albumin excretion at baseline and 1 year after therapy began. Twenty-two patients were randomized to valsartan and 20 to enalapril. The 2 treatment groups were similar in terms of age, sex distribution, and duration of diabetes or hypertension. Blood pressure decreased to a similar extent (−2.5% to −5.0%) with each drug. Similarly, the 24-hour urinary albumin excretion decreased by 5% to 6% with each drug. The albumin-creatinine ratio in early-morning urine samples and plasma creatinine levels decreased in the valsartan group and increased in the enalapril group, but the difference was not significant. Plasma potassium levels were stable in both groups at the end of study. Cough was reported by 7 (35%) patients receiving enalapril and none of those receiving valsartan (P=.003). In conclusion, enalapril and valsartan both reduced blood pressure and albuminuria to a similar extent with 1 year of therapy in Chinese patients with type 2 diabetes and normal renal function or early-stage nephropathy. Fewer adverse events were reported with valsartan, but both drugs appear to be relatively safe.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ritz E, Tarng DC. Renal disease in type 2 diabetes.Nephrol Dial Transplant. 2001;16(suppl 5):11–18.

    PubMed  Google Scholar 

  2. Lui SF. Chronic renal failure. In: Sung JY, Li PK, Sanderson JE, Woo J, eds.Textbook of Clinical Medicine for Asia. Hong Kong: The Chinese University Press; 1998:311–318.

    Google Scholar 

  3. Parving HH, Oxenboll B, Svendsen PA, et al. Early detection of patients at risk of developing diabetic nephropathy: a longitudinal study of urinary albumin excretion.Acta Endocrinol. 1982; 100:550–555.

    PubMed  CAS  Google Scholar 

  4. Tuttle KR, Stein JH, De Fronzo RA. The natural history of diabetic nephropathy.Semin Nephrol. 1990;10:184–193.

    PubMed  CAS  Google Scholar 

  5. Mathiesen E, Ronn B, Jensen T, et al. Relationship between blood pressure and urinary albumin excretion in development of microalbuminuria.Diabetes. 1990;39:245–249.

    Article  PubMed  CAS  Google Scholar 

  6. Ritz E. Hypertension in diabetic nephropathy: prevention and treatment.Am Heart J. 1993;125: 1514–1519.

    Article  PubMed  CAS  Google Scholar 

  7. Ruilope LM, Luno J. Angiotensin blockade in type 2 diabetic renal disease.Kidney Int Suppl. 2002;82:61–63.

    Article  PubMed  Google Scholar 

  8. Deferrari G, Ravera M, Berruti V. Treatment of diabetic nephropathy in its early stages.Diabetes Metab Res Rev. 2003;19:101-U4.

    Article  PubMed  CAS  Google Scholar 

  9. Yeung VT, Chan SH, Cheng KK, on behalf of MAPS investigators. Microalbuminuria Prevalence Study (MAPS) in hypertensive type 2 diabetic patients in Asia: Hong Kong data. The 5th Hong Kong Diabetes and Cardiovascular Risk Factors East-Meets-West Symposium, 2003. Abstract A0026.

  10. Dinneen SF, Gerstein HC. The association of microalbuminuria and mortality in non-insulindependent diabetes mellitus: a systematic overview of the literature.Arch Intern Med. 1997;157: 1413–1418.

    Article  PubMed  CAS  Google Scholar 

  11. Weinstock BW, Keane WF. Proteinuria and cardiovascular disease.Am J Kidney Dis. 2001; 38(suppl 1):S8-S13.

    Google Scholar 

  12. Hostetter TH. Mechanisms of diabetic nephropathy.Am J Kidney Dis. 1994;23:188–192.

    PubMed  CAS  Google Scholar 

  13. Kasiske BL, Kalil RS, Ma JZ, Liao M, Keane WF. Effect of antihypertensive therapy on the kidney in patients with diabetes: a meta-regression analysis.Ann Int Med. 1993;118:129–138.

    PubMed  CAS  Google Scholar 

  14. Chan JC, Ko GT, Leung D, et al. The long term effects of angiotensin converting enzyme inhibition and metabolic control on cardiovascular and renal outcomes in hypertensive type 2 diabetic patients.Kidney Int. 2000;57:590–600.

    Article  PubMed  CAS  Google Scholar 

  15. Brown NJ, Vaughan DE. Angiotensin-converting enzyme inhibitors.Circulation. 1998;97:1411–1420.

    PubMed  CAS  Google Scholar 

  16. Berl T. Angiotensin-converting enzyme inhibitors versus AT1 receptor antagonist in cardiovascular and renal protection: the case for AT1 receptor antagonist.J Am Soc Nephrol. 2004;15(suppl 1): S71-S76.

    Article  PubMed  Google Scholar 

  17. Parving HH, Lehnert H, Brochner-Mortensen J, Gomis R, Andersen S, Arner P, and the Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. NEngl J Med. 2001;345: 870–878.

    Article  PubMed  CAS  Google Scholar 

  18. Brenner BM, Cooper ME, de Zeeuw D, et al, and the RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. NEngl J Med. 2001;345:861–869.

    Article  PubMed  CAS  Google Scholar 

  19. Lewis EJ, Hunsicker LG, Clarke WR, et al, and the Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. NEngl J Med. 2001;345:851–860.

    Article  PubMed  CAS  Google Scholar 

  20. Viberti G, Wheeldon NM, for the Microalbuminuria Reduction With Valsartan (MARVAL) Study Investigators. Microalbuminuria reduction with valsartan in patients with type 2 diabetes: a blood pressure-independent effect.Circulation. 2002;106:672–678.

    Article  PubMed  CAS  Google Scholar 

  21. Taal MW, Brenner BM. Combination ACEI and ARB therapy: additional benefit in renoprotection?Curr Opin Nephrol Hypertens. 2002;ll:377–381.

    Article  Google Scholar 

  22. Ferrari P, Marti HP, Pfister M, Frey FJ. Additive antiproteinuric effect of combined ACE inhibition and angiotensin II receptor blockade.J Hypertens. 2002;20:125–130.

    Article  PubMed  CAS  Google Scholar 

  23. Lacourciere Y, Belanger A, Godin C, et al. Long-term comparison of losartan and enalapril on kidney function in hypertensive type 2 diabetics with early nephropathy.Kidney Int. 2000;58: 762–769.

    Article  PubMed  CAS  Google Scholar 

  24. Barnett AH, Bain SC, Bouter P, et al, and the Diabetics Exposed to Telmisartan and Enalapril Study Group. Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy.N Engl J Med. 2004;351:1952–1961.

    Article  PubMed  CAS  Google Scholar 

  25. Chan JC, Cockram CS, Nicholls MG, Cheung CK, Swaminathan R. Comparison of enalapril and nifedipine in treating NIDDM associated with hypertension: one year analysis.BMJ. 1992; 305:981–985.

    Article  PubMed  CAS  Google Scholar 

  26. Kumagai H, Sakata K, Matsuura T, et al. Comparison of ARB and ACEI for renoprotection in chronic glomerulonephritis [in Japanese].Nippon Rinsho. 2002;60:2005–2013.

    PubMed  Google Scholar 

  27. Matsuda H, Hayashi K, Homma K, et al. Differing anti-proteinuric action of candesartan and losartan in chronic renal disease.Hypertens Res. 2003;26:875–880.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, 11, Chuen On Road Tai Po, Hong Kong

    Gary T. C. Ko MBChB, FRCPI, Chiu-Chi Tsang MBBS, MRCP & Hamish C. K. Chan MBChB, FRCP

Authors
  1. Gary T. C. Ko MBChB, FRCPI
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chiu-Chi Tsang MBBS, MRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hamish C. K. Chan MBChB, FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ko, G.T.C., Tsang, CC. & Chan, H.C.K. Stabilization and regression of albuminuria in Chinese patients with type 2 diabetes: A one-year randomized study of valsartan versus enalapril. Adv Therapy 22, 155–162 (2005). https://doi.org/10.1007/BF02849886

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02849886

Keywords

Search

Navigation