Document Detail

Effective antihypertensive strategies for high-risk patients with diabetic nephropathy.
MedLine Citation:
PMID:  21030879     Owner:  NLM     Status:  MEDLINE    
AIM: Clinical guidelines recommend blood pressure (BP) lowering and renin-angiotensin-aldosterone system inhibition to slow kidney disease progression in patients with diabetic nephropathy. This study's purpose was to determine whether an antihypertensive regimen including a maximally dosed angiotensin-converting enzyme inhibitor could safely achieve target BP in indigent, predominantly minority patients with this disease.
METHODS: We studied 81 hypertensive adults (52% Hispanic and 31% African American) with nephropathy attributed to type 1 or 2 diabetes during the run-in period of a randomized controlled trial. The subjects received lisinopril titrated to 80 mg daily and additional antihypertensives to target a systolic BP (SBP) lower than 130 mm Hg. Blood pressure and serum potassium level were measured weekly, and a 4-gram sodium diet was prescribed. The primary outcome variable was SBP change from screening to randomization. Success in achieving SBP goal, change in urine albumin-creatinine ratio, hyperkalemia (serum potassium ≥5.5 mmol/L) and hypotension (SBP < 100 mm Hg) were also analyzed.
RESULTS: The median SBP decreased from 144 to 133 mm Hg (median change, -9.6%.) Fifty-eight (71%) achieved goal SBP during run-in. The median UACR decreased from 206.8 to 112.7 mg/mmol (median change, -42.7%). The UACR reduction correlated with SBP reduction. Seventeen subjects experienced hyperkalemia responsive to dietary/medical management. Two subjects experienced hypotension responsive to medication adjustments.
CONCLUSION: A regimen using a maximally dosed angiotensin-converting enzyme inhibitor is safe and effective for achieving BP goal in high-risk, predominantly minority patients with diabetic nephropathy. Implementing this regimen necessitates close monitoring of serum potassium level.
Peter Noel Van Buren; Beverley Adams-Huet; Robert Daniel Toto
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of investigative medicine : the official publication of the American Federation for Clinical Research     Volume:  58     ISSN:  1708-8267     ISO Abbreviation:  J. Investig. Med.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-03-29     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  9501229     Medline TA:  J Investig Med     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  950-6     Citation Subset:  IM    
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Antihypertensive Agents / therapeutic use*
Blood Pressure / drug effects
Diabetic Nephropathies / complications,  drug therapy*
Drug Therapy, Combination
Hypertension / drug therapy*,  etiology
Lisinopril / therapeutic use*
Middle Aged
Grant Support
2-R01 DK6301001/DK/NIDDK NIH HHS; K24 DK 002818/DK/NIDDK NIH HHS; K24 DK002818/DK/NIDDK NIH HHS; K24 DK002818-10/DK/NIDDK NIH HHS; M01-RR-00633/RR/NCRR NIH HHS; R01 DK063010/DK/NIDDK NIH HHS; R01 DK063010-01/DK/NIDDK NIH HHS; UL1 RR024982/RR/NCRR NIH HHS; UL1 RR024982-04/RR/NCRR NIH HHS; UL1-RR-024982/RR/NCRR NIH HHS
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; E7199S1YWR/Lisinopril

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

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