title: [The nephroprotective effect of ramipril. Effect on blood pressure and metabolic control in insulin-treated patients with type-2 diabetes mellitus].
abstract: OBJECTIVE
  Investigation of the impact of blood pressure and metabolic control on the nephroprotective effect of ramipril in insulin-dependent diabetics.
  
  
  METHODS
  Within the framework of an open prospective therapeutic trial, 18 hypertensive, insulin-treated diabetics received ramipril, 5 mg/day, for an average period of 11 months. All the patients had previously received various forms of antihypertensive medication, and had microalbuminuria.
  
  
  RESULTS
  Urinary excretion of albumin and N-acetyl-beta-D-glucosaminidase decreased in 13 patients (group 1), but increased in the remaining five patients (group 2). Blood pressure clearly decreased in group 1, but remained constant in group 2. In terms of clinical and biochemical data, the group 2 patients differed from those in group 1, having a lower age, a shorter history of diabetes and higher hemoglobin A1c levels despite higher doses of insulin.
  
  
  CONCLUSIONS
  The present observations show that inadequate metabolic control and refractory hypertension in type 2 diabetics accelerate progression of diabetic nephropathy, and may thus negate the nephroprotective effect of the converting enzyme inhibitor, ramipril.
authors.affiliation: St. Vinzenz Hospital Wiedenbrück, Rheda-Wiedenbrück.
authors.forename: E
authors.initials: E
authors.lastname: Jungmann
authors.forename: K
authors.initials: K
authors.lastname: Krüger
authors.forename: B
authors.initials: B
authors.lastname: Semler
authors.forename: T
authors.initials: T
authors.lastname: Haak
authors.forename: J
authors.initials: J
authors.lastname: Scherberich
authors.forename: P M
authors.initials: PM
authors.lastname: Schumm-Draeger
authors.forename: K H
authors.initials: KH
authors.lastname: Usadel
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000097:blood / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017257:Ramipril / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D007328:Insulin; D017257:Ramipril
vernacular_title: Nephroprotektive Wirkung von Ramipril. Einfluss von Blutdruck- und Stoffwechseleinstellung bei Insulin-behandelten Patienten mit Typ-2-Diabetes mellitus.