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Titolo:
PLACEBO-CONTROLLED TRIAL OF LISINOPRIL IN NORMOTENSIVE DIABETIC-PATIENTS WITH INCIPIENT NEPHROPATHY
Autore:
ODONNELL MJ; ROWE BR; LAWSON N; HORTON A; GYDE OH; BARNETT AH;
Indirizzi:
E BIRMINGHAM DIST GEN HOSP,UNDERGRAD TEACHING CTR,BORDESLEY GREEN E BIRMINGHAM B9 5ST W MIDLANDS ENGLAND UNIV BIRMINGHAM,DEPT MED BIRMINGHAM B15 2TT W MIDLANDS ENGLAND
Titolo Testata:
Journal of human hypertension
fascicolo: 4, volume: 7, anno: 1993,
pagine: 327 - 332
SICI:
0950-9240(1993)7:4<327:PTOLIN>2.0.ZU;2-2
Fonte:
ISI
Lingua:
ENG
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
NO
Recensione:
Indirizzi per estratti:
Citazione:
M.J. Odonnell et al., "PLACEBO-CONTROLLED TRIAL OF LISINOPRIL IN NORMOTENSIVE DIABETIC-PATIENTS WITH INCIPIENT NEPHROPATHY", Journal of human hypertension, 7(4), 1993, pp. 327-332

Abstract

To study the effects of an angiotensin converting enzyme inhibitor, lisinopril, on renal function in incipient diabetic nephropathy, a prospective double-blind randomised placebo-controlled single centre studywas set up at our outpatient diabetic-renal clinic. There were 27 patients with Type I and Type II diabetes with an albumin excretion rate of between 20 mug/min and 200 mug/min, respectively and no hypertension. Intervention treatment with placebo or low dose lisinopril was for 48 weeks. The main outcome changes were in urinary albumin excretion rate, urinary prostaglandin excretion, and glomerular filtration rate. Secondary outcome measures included changes in BP and heart rate. Of the 32 patients entered into the study, 27 completed 48 weeks treatment(12 lisinopril, 15 placebo). Mean (+/- SD) urinary albumin excretion rate fell from 57.6 (25.7) mug/min (n = 15) at visit 1 to 26.8 (26.7) mug/min (n = 12) at visit 7 after 48 weeks treatment in the lisinoprilgroup but not in the placebo group: 119.2 (I 16.6) mug/min (n = 17) vs. 11 3.7 (77.0) mug/min (n = 15) There was a least squares mean treatment difference of -67.6 mug/min (95% confidence interval (CI), -115.0to -20.2, P < 0.01) in favour of lisinopril compared with placebo. After 48 weeks treatment seven lisinopril treated patients were normoalbuminuric and five were microproteinuric; three placebo treated patients were normoalbuminuric, nine were microalbuminuric and three were macroproteinuric. Excretion of prostaglandin-F1alpha (PGF1alpha) and thromboxane-B2 (TXB2) fell in the lisinopril treated group. Treatment differences between groups were not significant (-18.9 pg/min, 95% Cl -138.6 to 100.9, P = 0.74 for PGF1alpha and 105.4 pg/min, 95% Cl -385.2 to174.4, P = 0.43 for TXB2) in favour of lisinopril (n = 9) compared with placebo (n = 8). Glomerular filtration rate fell from 126.9 (46.7) to 100.8 (27.4) ml/min per 1.73 m2 (n = 15) for lisinopril and from 110.8 (34.0) to 103.1 (38.3) ml/min per 1.73 m2 (n = 17) for placebo treated patients. The decrease was larger in the lisinopril group (15.7 ml/min per 1.73 m2, 95% Cl -41,5 to 10.1, P = 0.22). Heart rate did notalter significantly in either group: 78.5 (13.9)beats/min at visit 1 and 80.5 (11.8) beats/min at visit 7 for lisinopril and 80.9 (10.4) beats/min and 79.9 (8.4) beats/min for placebo treated. SBP fell in the lisinopril group from 137 (20) mmHg (n = 15) to 125 (19) mmHg (n = 12)but did not after in the placebo group: 136 (26) mmHg (n = 17) and 138 (23) mmHg (n = 15). The treatment of normotensive microproteinuric diabetic patients. with lisinopril for 48 weeks appears to protect against the development of macroalbuminuria. The reduction in urinary albumin excretion rate appears to be independent of reductions in systemicBP or alterations in urinary prostaglandin excretion.

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Documento generato il 23/11/20 alle ore 21:42:24