Prevention of diabetic nephropathy with enalapril in normotensive diabetics with microalbuminuria.
OBJECTIVE
To assess the effectiveness of inhibition of angiotensin converting enzyme in preventing diabetic nephropathy.


METHODS
Randomised follow up study of normotensive diabetics with persistent microalbuminuria (30-300 mg/24 hours) treated with enalapril or its matched placebo for one year. Double blind for first six months, single blind for last six months.


METHODS
Diabetic clinic in tertiary referral centre.


METHODS
Treatment group and placebo group each comprised 10 normotensive diabetics with persistent microalbuminuria.


METHODS
Treatment group was given enalapril 20 mg daily and controls matched placebo. Patients were given antihypertensive treatment after one year.


METHODS
Albumin excretion, arterial pressure, and renal function.


RESULTS
In last three months of trial three of 10 patients taking placebo had diabetic nephropathy (albumin excretion greater than 300 mg/24 hours). No patients taking enalapril developed nephropathy and five showed normal albumin excretion (less than 30 mg/24 hours) (p = 0.005, Mann-Whitney test). Mean arterial pressure was reduced by enalapril throughout study (p less than 0.005) but increased linearly with placebo (p less than 0.05). Albumin excretion decreased linearly with enalapril but not placebo. An increase in albumin excretion with placebo was positively related to the increase in mean arterial pressure (r = 0.709, p less than 0.05, Spearman's rank test). With enalapril total renal resistances and fractional albumin clearances improved progressively (time effect, p = 0.0001).


CONCLUSIONS
Inhibition of angiotensin converting enzyme prevents development of nephropathy in normotensive diabetics with persistent microalbuminuria. This may be due to reduction in intraglomerular pressure and to prevention of increased systemic blood pressure. Future studies should compare long term effects of inhibitors of converting enzyme with other antihypertensive drugs.
Marre
M
M
Service de Diabétologie, Hôpital Saint-Louis, Paris, France.
Chatellier
G
G
Leblanc
H
H
Guyene
T T
TT
Menard
J
J
Passa
P
P
D000328:Adult; D000419:Albuminuria / Q000503:physiopathology / Q000517:prevention & control*; D001794:Blood Pressure; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000503:physiopathology / Q000517:prevention & control* / Q000652:urine; D004311:Double-Blind Method; D004656:Enalapril / Q000627:therapeutic use*; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008875:Middle Aged; D011897:Random Allocation
D004656:Enalapril