| Long-term comparison between perindopril and nifedipine in normotensive patients with type 1 diabetes and microalbuminuria. | |
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MedLine Citation:
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PMID: 11325669 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The aim of this study is to compare the efficacy of an angiotensin-converting enzyme inhibitor with a dihydropyridine calcium channel blocker in preventing progression to macroalbuminuria and/or a decline in renal function in normotensive patients with type 1 diabetes and microalbuminuria. Forty-two patients were randomized to treatment with either perindopril, slow-release nifedipine, or placebo. In the first 3 months, drug dosage was titrated to achieve a decrease in diastolic blood pressure of at least 5 mm HG: Thirty-three patients had a minimum of 24 months' data, and 25 patients were followed up beyond 36 months (mean, 67 +/- 4 months). Patients were studied every 3 months and at the end of the treatment period; those who remained normotensive discontinued therapy and were followed up for an additional 3 months. Baseline geometric mean albumin excretion rates (AERs) were as follows: perindopril, 66 microg/min; nifedipine, 59 microg/min; and placebo, 66 microg/min. During the first 3 years, 7 of the perindopril-treated but none of the placebo or nifedipine-treated patients reverted to normoalbuminuria (P < 0.01). Median AERs at 3 years of treatment in each group were 23 microg/min for perindopril, 122 microg/min for nifedipine, and 112 microg/min for placebo patients (P < 0.01). In patients with more than 3 years' follow-up, median AERs decreased by 45% in the first year and then stabilized in the perindopril group, but increased by 17.6% in the nifedipine group and 27.6% in the placebo group (P < 0.03) in the first year, then increased progressively. In these same patients, there was a significant decline in glomerular filtration rate in the nifedipine group (-7.8 +/- 1.8 mL/min/1.73 m(2)/y), but not in the other two groups (perindopril, -1.0 +/- 1.2 mL/min/1.73 m(2)/y; placebo, -1.3 +/- 1.1 mL/min/1.73 m(2)/y; P = 0.004). At the end of the study, cessation of treatment for 3 months was associated with a doubling of AERs in the perindopril-treated group, but no change in the other two groups (P < 0.001). In conclusion, long-term perindopril therapy is more effective than nifedipine or placebo in delaying the progression of diabetic nephropathy and reducing AER to the normoalbuminuric range (<20 microg/min) in normotensive patients with type 1 diabetes and microalbuminuria. |
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Authors:
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G Jerums; T J Allen; D J Campbell; M E Cooper; R E Gilbert; J J Hammond; J Raffaele; C Tsalamandris |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: American journal of kidney diseases : the official journal of the National Kidney Foundation Volume: 37 ISSN: 1523-6838 ISO Abbreviation: Am. J. Kidney Dis. Publication Date: 2001 May |
Date Detail:
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Created Date: 2001-10-16 Completed Date: 2001-10-25 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8110075 Medline TA: Am J Kidney Dis Country: United States |
Other Details:
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Languages: eng Pagination: 890-9 Citation Subset: IM |
Affiliation:
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Department of Medicine, University of Melbourne, Austin & Repatriation Medical Centre, Heidelberg 3084, VIC, Australia. endo@austin.unimelb.edu.au |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Albuminuria / prevention & control* Angiotensin-Converting Enzyme Inhibitors / therapeutic use* Antihypertensive Agents / therapeutic use* Blood Pressure / drug effects Calcium Channel Blockers / therapeutic use* Diabetes Mellitus, Type 1 / complications*, urine Diabetic Nephropathies / prevention & control* Female Follow-Up Studies Humans Male Middle Aged Nifedipine / therapeutic use* Perindopril / therapeutic use* Prospective Studies Statistics as Topic |
| Chemical | |
Reg. No./Substance:
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0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Calcium Channel Blockers; 21829-25-4/Nifedipine; 82834-16-0/Perindopril |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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