title: Dual blockade of angiotensin II with enalapril and losartan reduces proteinuria in hypertensive patients with type 2 diabetes.
abstract: In this study we evaluated the effect of a dual blockade with enalapril and losartan on the reduction of overt macroproteinuria and its potential mechanism(s) in hypertensive patients with type 2 diabetes. Twenty-six hypertensive patients with type 2 diabetes at the baseline were administered 5 mg of enalapril once daily for 12 weeks. At the beginning of the study, the subjects were assigned to receive an add-on of 50 mg of losartan once daily or 5 mg of enalapril once daily for another 12 weeks. Blood samples were collected at the baseline, at the beginning, and at the end of the study for the measurement of laboratory parameters, and these data, including blood pressure, were compared between the two groups. Treatment with 5 mg of enalapril significantly decreased the systolic blood pressure level in both groups, and the addition of losartan and/or enalapril further decreased the levels. There was no difference in blood pressure between the two groups. However, the addition of losartan, but not enalapril, significantly decreased the urinary protein excretion level, plasma aldosterone, and hypersensitive-C-reactive protein at the end of the study. The results established that the dual blockade of angiotensin II with enalapril and losartan has a greater clinical benefit for high-risk patients with hypertension and advanced diabetic nephropathy.
authors.affiliation: Department of Laboratory Medicine, Yamagata University School of Medicine, Yamagata, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Igarashi
authors.forename: Akihiko
authors.initials: A
authors.lastname: Hirata
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kadomoto
authors.forename: Makoto
authors.initials: M
authors.lastname: Tominaga
mesh_terms: D000368:Aged; D000450:Aldosterone / Q000097:blood; D000804:Angiotensin II / Q000037:antagonists & inhibitors* / Q000097:blood; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage; D002097:C-Reactive Protein / Q000378:metabolism; D055316:Cystatin C; D015891:Cystatins / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000652:urine*; D003928:Diabetic Nephropathies / Q000097:blood / Q000150:complications / Q000517:prevention & control / Q000652:urine; D004656:Enalapril / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000652:urine*; D019808:Losartan / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D011507:Proteinuria / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000652:urine; D016212:Transforming Growth Factor beta / Q000097:blood / Q000652:urine
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D016212:Transforming Growth Factor beta; D000804:Angiotensin II; D020097:Natriuretic Peptide, Brain; D000450:Aldosterone; D004656:Enalapril; D002097:C-Reactive Protein; D019808:Losartan