| Effective antihypertensive strategies for high-risk patients with diabetic nephropathy. | |
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MedLine Citation:
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PMID: 21030879 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Peter Noel Van Buren; Beverley Adams-Huet; Robert Daniel Toto |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural |
Journal Detail:
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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:
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Created Date: 2010-11-24 Completed Date: 2011-03-29 Revised Date: 2012-01-02 |
Medline Journal Info:
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Nlm Unique ID: 9501229 Medline TA: J Investig Med Country: Canada |
Other Details:
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Languages: eng Pagination: 950-6 Citation Subset: IM |
Affiliation:
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Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8523, USA. vanburenp@gmail.com |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Angiotensin-Converting Enzyme Inhibitors / therapeutic use* Antihypertensive Agents / therapeutic use* Blood Pressure / drug effects Diabetic Nephropathies / complications, drug therapy* Drug Therapy, Combination Female Humans Hypertension / drug therapy*, etiology Lisinopril / therapeutic use* Male Middle Aged |
| Grant Support | |
ID/Acronym/Agency:
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2-R01 DK6301001/DK/NIDDK NIH HHS; K24 DK 002818/DK/NIDDK NIH HHS; K24 DK002818-10/DK/NIDDK NIH HHS; M01-RR-00633/RR/NCRR NIH HHS; R01 DK063010-01/DK/NIDDK NIH HHS; UL1 RR024982-04/RR/NCRR NIH HHS; UL1-RR-024982/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 83915-83-7/Lisinopril |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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