Losartan reduces microalbuminuria in hypertensive microalbuminuric type 2 diabetics.
BACKGROUND
The aim of the present study was to assess the antialbuminuric effect of losartan in a large number of hypertensive type 2 diabetics.


METHODS
This was a 6-month, open-label, prospective and multicentre study. A total of 422 patients with type 2 diabetes who were hypertensive [sitting systolic blood pressure (SBP) > or = 140 mmHg and/or diastolic blood pressure (DBP) > or = 90 mmHg] and microalbuminuric [urinary albumin excretion (UAE) 30-300 mg/day] were eligible for the study. After a 2-week run-in period, patients were placed on losartan 50 mg once a day. If the BP did not reach the desired goal (< 140/90 mmHg) after a 4-week period, the losartan dose was doubled. In the absence of control of BP, losartan 50 mg/day+hydroclorothiazide 12.5 mg/day was administrated. Initially and at 12 and 24 weeks of active treatment, BP, UAE, HbA(1c) and other renal function parameters were evaluated.


RESULTS
A significant decrease in SBP and DBP was observed, as well as in parameters reflecting metabolic control, fasting glucose and HbA(1c). UAE also decreased significantly, but the percentage of the variance of change in UAE explained by the changes in SBP and HbA(1c) was, however, negligible, i.e. 4%. Moreover, small but significant reductions in uric acid, total cholesterol and triglycerides, and an increase in HDL-cholesterol levels were also observed.


CONCLUSIONS
Antihypertensive treatment with losartan exerts a beneficial effect on UAE, a benchmark for measuring the efficacy of therapeutic interventions in diabetic nephropathy, by reducing BP and allowing better diabetes control. The role of other mechanisms influencing the favourable outcome, beyond these measured effects, needs to be assessed in further studies.
Lozano
J V
JV
Hypertension Clinic, Internal Medicine, Hospital Clinico, Valencia, Spain.
Llisterri
J L
JL
Aznar
J
J
Redon
J
J
D000419:Albuminuria / Q000517:prevention & control*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects*; D001835:Body Weight; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000188:drug therapy*; D003971:Diastole / Q000187:drug effects; D004359:Drug Therapy, Combination; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D019808:Losartan / Q000627:therapeutic use*; D012044:Regression Analysis; D013599:Systole / Q000187:drug effects; D014527:Uric Acid / Q000097:blood
D000959:Antihypertensive Agents; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D006852:Hydrochlorothiazide; D019808:Losartan; D014527:Uric Acid