Document Detail


Differential effects of beta-blockers on albuminuria in patients with type 2 diabetes.
MedLine Citation:
PMID:  16286578     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Increases in the cardiovascular risk marker microalbuminuria are attenuated by blood pressure reduction using blockers of the renin-angiotensin system. Such changes in microalbuminuria have not been observed when beta-blockers are used. A prespecified secondary end point of the Glycemic Effects in Diabetes Mellitus Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial was to examine the effects of different beta-blockers on changes in albuminuria in the presence of renin-angiotensin system blockade. Participants with hypertension and type 2 diabetes were randomized to either metoprolol tartrate (n=737) or carvedilol (n=498) in blinded fashion after a washout period of all antihypertensive agents except for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Blinded medication was titrated to achieve target blood pressure, with a-5 month follow-up period. The current analysis examined microalbuminuria, using spot urine albumin:creatinine, in participants who had values at screening and trial end. A greater reduction in microalbuminuria was observed for those randomized to carvedilol (-16.2%Delta; 95% confidence interval, -25.3, -5.9; P=0.003). Of those with normoalbuminuria at baseline, fewer progressed to microalbuminuria on carvedilol versus metoprolol (20 of 302 [6.6%] versus 48 of 431 [11.1%], respectively; P=0.03). Microalbuminuria development was not related to differences in blood pressure or achievement of blood pressure goal (68% carvedilol versus 67%, metoprolol). Presence of metabolic syndrome at baseline was the only independent predictor of worsening albuminuria throughout the study (P=0.004). Beta-blockers have differential effects on microalbuminuria in the presence of renin-angiotensin system blockade. These differences cannot be explained by effects on blood pressure or alpha1-antagonism but may relate to antioxidant properties of carvedilol.
Authors:
George L Bakris; Vivian Fonseca; Richard E Katholi; Janet B McGill; Franz Messerli; Robert A Phillips; Philip Raskin; Jackson T Wright; Brian Waterhouse; Mary Ann Lukas; Karen M Anderson; David S H Bell;
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Publication Detail:
Type:  Journal Article     Date:  2005-11-14
Journal Detail:
Title:  Hypertension     Volume:  46     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-11-24     Completed Date:  2005-12-21     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1309-15     Citation Subset:  IM    
Affiliation:
Rush University Medical Center, Chicago, IL 60612, USA. gbakris@earthlink.net
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use*
Adult
Aged
Aged, 80 and over
Albuminuria / drug therapy*,  etiology*,  physiopathology
Blood Pressure
Carbazoles / therapeutic use*
Creatinine / urine
Diabetes Mellitus, Type 2 / physiopathology,  urine*
Double-Blind Method
Female
Humans
Male
Metoprolol / therapeutic use*
Middle Aged
Multivariate Analysis
Propanolamines / therapeutic use*
Randomized Controlled Trials as Topic
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Carbazoles; 0/Propanolamines; 0K47UL67F2/carvedilol; 37350-58-6/Metoprolol; 60-27-5/Creatinine
Comments/Corrections
Comment In:
Hypertension. 2005 Dec;46(6):1254-5   [PMID:  16286577 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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