Document Detail


A clinical trial in type 2 diabetic nephropathy.
MedLine Citation:
PMID:  11576953     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A prospective, randomized, three-armed, double-blind, placebo-controlled clinical trial has been completed in 210 sites worldwide to determine whether the angiotensin II receptor blocker irbesartan or the calcium channel blocker amlodipine has a renoprotective effect in patients with overt type 2 diabetic nephropathy. A total of 1,715 subjects randomized during a 3-year period were followed a minimum of 2 years. The goal for all treatment groups was to achieve equivalent blood pressure control, with the blinded study drug (irbesartan, amlodipine, or placebo) as primary therapy with additional antihypertensive drugs, excluding angiotensin-converting enzyme inhibitors, calcium antagonists, and angiotensin II receptor antagonists, to achieve seated systolic blood pressure less than 135 mm Hg and diastolic blood pressure less than 85 mm Hg. The primary outcome was the combined endpoint of time to doubling of entry serum creatinine, end-stage renal disease, or death. Secondary outcomes included fatal and nonfatal cardiovascular events. A Clinical Management Committee monitored the conduct of the study. An Outcome Confirmation Committee classified all study outcome events in blinded fashion. An external Data Safety Monitoring Committee monitored unblinded data for interim safety and efficacy analyses of the study. Eligibility criteria included informed consent, age 30 to 70 years, adult-onset diabetes, hypertension, urine protein excretion greater than 900 mg/24 hours, and serum creatinine values of 90 to 265 micromol/L in women and 110 to 265 micromol/L in men. Baseline characteristics were age, 59 +/- 8 years; body mass index, 31 +/- 7 kg/m(2); 67% male; 73% white, 14% black, and 13% other; duration of diabetes, 15 +/- 9 years; retinopathy, 66%; neuropathy, 48%; congestive heart failure, 7.5%; screening seated systolic blood pressure, 156 +/- 18 mm Hg, and diastolic blood pressure, 85 +/- 11 mm Hg; urine protein excretion, 4.0 +/- 3.5 g/24 hours; serum creatinine, 150 +/- 53 micromol/L; serum potassium, 4.6 +/- 0.5 mEq/L; total cholesterol, 229 +/- 58 mg/dL; and hemoglobin A(1c), 8.1 +/- 1.7%. This large-scale international trial should help define the clinical course and standards of care for hypertensive adults with type 2 diabetes mellitus and nephropathy. Results available on May 19, 2001, will help in defining the current controversy of the risks and benefits of blockade of the renin-angiotensin system versus calcium channel blockade versus standard antihypertensive therapy in this large patient population.
Authors:
E J Lewis; L G Hunsicker; R A Rodby;
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  38     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2001 Oct 
Date Detail:
Created Date:  2001-09-28     Completed Date:  2001-12-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S191-4     Citation Subset:  IM    
Affiliation:
Section of Nephrology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL, USA. hfollmer@rush.edu.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Amlodipine / therapeutic use
Biphenyl Compounds / therapeutic use*
Calcium Channel Blockers / therapeutic use
Diabetes Mellitus, Type 2 / complications*
Diabetic Angiopathies / complications,  drug therapy*
Diabetic Nephropathies / etiology,  prevention & control*
Double-Blind Method
Female
Humans
Hypertension / complications,  drug therapy*
Male
Middle Aged
Prospective Studies
Proteinuria / diagnosis,  etiology
Receptors, Angiotensin / antagonists & inhibitors*
Tetrazoles / therapeutic use*
Chemical
Reg. No./Substance:
0/Biphenyl Compounds; 0/Calcium Channel Blockers; 0/Receptors, Angiotensin; 0/Tetrazoles; 138402-11-6/irbesartan; 88150-42-9/Amlodipine

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


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