Document Detail

Effects of different ACE inhibitor combinations on albuminuria: results of the GUARD study.
MedLine Citation:
PMID:  18354383     Owner:  NLM     Status:  MEDLINE    
Clinical practice guidelines recommend blockers of the renin-angiotensin system alone or in combination with other agents to reduce blood pressure and albuminuria in patients with type 2 diabetes. Dihydropyridine calcium channel blockers, however, may lower blood pressure but not albuminuria in these patients. Here we tested the hypothesis that combining an ACE inhibitor with either a thiazide diuretic or a calcium channel blocker will cause similar reductions in blood pressure and albuminuria in hypertensive type 2 diabetics. We conducted a double blind randomized controlled trial on 332 hypertensive, albuminuric type 2 diabetic patients treated with benazepril with either amlodipine or hydrochlorothiazide for 1 year. The trial employed a non-inferiority design. Both combinations significantly reduced the urinary albumin to creatinine ratio and sitting blood pressure of the entire cohort. The percentage of patients progressing to overt proteinuria was similar for both groups. When we examined patients who had only microalbuminuria and hypertension we found that a larger percentage of the diuretic and ACE inhibitor normalized their albuminuria. We conclude that initial treatment using benzaepril with a diuretic resulted in a greater reduction in albuminuria compared to the group of ACE inhibitor and calcium channel blocker. In contrast, blood pressure reduction, particularly the diastolic component, favored the combination with amilodipine. The dissociation between reductions in blood pressure and albuminuria may be related to factors other than blood pressure.
G L Bakris; R D Toto; P A McCullough; R Rocha; D Purkayastha; P Davis;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2008-03-19
Journal Detail:
Title:  Kidney international     Volume:  73     ISSN:  1523-1755     ISO Abbreviation:  Kidney Int.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-05-15     Completed Date:  2008-07-21     Revised Date:  2009-01-07    
Medline Journal Info:
Nlm Unique ID:  0323470     Medline TA:  Kidney Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1303-9     Citation Subset:  IM    
Hypertensive Diseases Unit, Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
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MeSH Terms
Aged, 80 and over
Albuminuria / drug therapy*,  etiology
Amlodipine / adverse effects,  therapeutic use
Angiotensin-Converting Enzyme Inhibitors / adverse effects,  pharmacology,  therapeutic use*
Antihypertensive Agents / adverse effects,  therapeutic use
Benzazepines / adverse effects,  pharmacology,  therapeutic use*
Blood Pressure / drug effects
Calcium Channel Blockers / adverse effects,  therapeutic use
Diabetes Mellitus, Type 2 / complications*
Diabetic Nephropathies / drug therapy*,  etiology
Diuretics / adverse effects,  therapeutic use
Double-Blind Method
Drug Therapy, Combination
Hydrochlorothiazide / adverse effects,  therapeutic use
Hypertension / drug therapy,  etiology
Middle Aged
Treatment Outcome
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Benzazepines; 0/Calcium Channel Blockers; 0/Diuretics; 58-93-5/Hydrochlorothiazide; 86541-75-5/benazepril; 88150-42-9/Amlodipine
Comment In:
Kidney Int. 2008 Nov;74(10):1358; author reply 1358-9   [PMID:  18974763 ]

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

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