title: Antihypertensive treatment: long-term reversal of progression of albuminuria in incipient diabetic nephropathy. A longitudinal study of renal function.
abstract: This study was undertaken to clarify whether antihypertensive treatment has any effect on the rate of progression of kidney disease in patients with incipient diabetic nephropathy. Six insulin-dependent diabetic men with incipient nephropathy (urinary albumin excretion above 15 micrograms/min and total protein excretion below 0.5 g/24 h) were first given metoprolol (200 mg daily) with the subsequent addition of hydroflumethiazide. At the start of antihypertensive treatment, mean patient age was 32 +/- 4.2 years (SD) and mean duration of diabetes was 18 +/- 1.2 years. The patients were followed with repeated measurements of urinary albumin excretion for a mean of 5.4 +/- 3.1 years prior to, and for 4.7 +/- 1.3 years (SD) during treatment. Mean arterial blood pressure declined significantly during treatment, e.g., the values at 6 months before initiation of treatment being compared with values during the last 6 months of treatment fell from 107 mmHg +/- 7.6 to 93 +/- 3.8 (2p = 1.5%). Albumin excretion decreased from 131.0 micrograms/min X/divided by 2.9 (geometric mean X/divided by tolerance factor) to 41.7 micrograms/min X/divided by 2.9 (2p = 1.2%). Albumin clearance in per cent of glomerular filtration rate decreased from a mean of 0.0030 +/- 0.0019% (SD) to 0.0011 +/- 0.0010% (2p = 4.6%). The mean yearly increase in urinary albumin excretion before treatment was 18.0 +/- 17.0% (mean +/- SD); during treatment urinary albumin excretion decreased 19 +/- 10% per year (2p = 0.7%). No changes were seen in renal plasma flow (516 +/- 31.0 ml/min to 520 +/- 66 ml/min (n = 5)).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Second University Clinic of Internal Medicine, Kommunehospitalet, Aarhus C, Denmark.
authors.forename: C K
authors.initials: CK
authors.lastname: Christensen
authors.forename: C E
authors.initials: CE
authors.lastname: Mogensen
mesh_terms: D000328:Adult; D000419:Albuminuria; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure / Q000187:drug effects; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000188:drug therapy / Q000503:physiopathology*; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006857:Hydroflumethiazide / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D012039:Regional Blood Flow; D012079:Renal Circulation; D001613:beta 2-Microglobulin / Q000652:urine
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D006857:Hydroflumethiazide; D008790:Metoprolol; D001613:beta 2-Microglobulin