[Dissociation of hypotensive and renal hemodynamic effects of an angiotensin converting enzyme inhibitor in insulin-dependent diabetic patients with incipient nephropathy].
The mechanism of action of angiotensin converting enzyme (ACE) inhibitors on urinary albumin excretion (UAE) in diabetics is controversial. In order to dissociate the hypotensive and intrarenal effects, 16 insulin-dependant diabetics with permanent microalbuminuria (30-300 mg/24 h) without hypertension were given Ramipril, a long acting ACE inhibitor, at hypotensive (treatment A 5 mg/day; N = 8) and at sub-hypotensive doses (treatment B, 1.25 mg/day; N = 8) over a 6 week period in parallel double-blind study. Blood pressure, UAE, glomerular filtration renal blood flow (continuous 125I-Iodothalamate + 131I-Hippurate infusion) and converting enzyme activity (Liebermann's method), before and after treatment. In treatment group A, the blood pressure fell from 133 +/- 5/79 +/- 4 (mean +/- SE) to 125 +/- 4/77 +/- 2 mmHg (p less than 0.05 for systolic blood pressure) whereas it remained stable in treatment group B (132 +/- 7/79 +/- 4 to 128 +/- 5/80 +/- 4 mmHg). The UAE decreased in both groups: group A from an average of 74 (40-198) to 47 (5-202) mg/24 h (p = 0.07; group B, from an average of 77 (50-136) to 19 (15-120) mg/24 h (p less than 0.005), as did ACE activity: group A from 332 +/- 44 to 163 +/- 33 iu/l (p less than 0.004), group B from 423 +/- 39 to 191 +/- 28 iu/l (p less than 10-4).(ABSTRACT TRUNCATED AT 250 WORDS)
Hallab
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M
Unité de diabétologie, CHRU Angers.
Billiard
A
A
Lejeune
J J
JJ
Bled
F
F
Girault
A
A
Fressinaud
P
P
Marre
M
M
D000328:Adult; D000368:Aged; D000419:Albuminuria; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D001643:Bridged Bicyclo Compounds / Q000494:pharmacology*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000188:drug therapy*; D005260:Female; D005919:Glomerular Filtration Rate; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D017257:Ramipril; D012039:Regional Blood Flow / Q000187:drug effects
D000806:Angiotensin-Converting Enzyme Inhibitors; D001643:Bridged Bicyclo Compounds; D017257:Ramipril
Dissociation des effets hypotenseurs et hémodynamiques rénaux d'un inhibiteur de l'enzyme de conversion chez des diabétiques insulinodépendants avec néphropathie débutante.