title: Albuminuria response to very high-dose valsartan in type 2 diabetes mellitus.
abstract: OBJECTIVE
  Renin-angiotensin system blockade is now standard in the management of the patient with type 2 diabetes mellitus. We aimed to investigate whether high doses of valsartan, an angiotensin receptor blocker, are superior to conventional doses to reduce urinary albumin excretion rates (UAER) in such patients.
  
  
  METHODS
  Three hundred and ninety-one hypertensive patients with type 2 diabetes mellitus and UAER 20-700 microg/min were randomized to 160, 320 or 640 mg valsartan. All received valsartan 160 mg for the first 4 weeks. Valsartan dose was then increased in two of three groups for 30 weeks. Overnight urine collections at baseline, 4, 16, and 30 weeks in triplicate were used to assess proteinuria.
  
  
  RESULTS
  Comparable albuminuria reductions occurred in all groups at week 4 (P<0.001). Subsequently, a highly significant albuminuria fall occurred with valsartan 320 and 640 mg (P<0.001) versus a modest additional change with 160 mg (P=0.03). At week 30, twice as many patients returned to normal albuminuria with valsartan 640 mg versus 160 mg (24 versus 12%; P<0.01). High doses were well tolerated, with no dose-related increases in adverse events, including hypotension and hyperkalemia.
  
  
  CONCLUSIONS
  High doses of valsartan reduced albuminuria more than the more commonly used 160 mg dose, apparently independent of blood pressure. Thus, at least in type 2 diabetes mellitus, higher doses of valsartan are required to optimize tissue protection than for blood pressure control.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA. djpagecapo@rics.bwh.harvard.edu
authors.forename: Norman K
authors.initials: NK
authors.lastname: Hollenberg
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Parving
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Viberti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Remuzzi
authors.forename: Susan
authors.initials: S
authors.lastname: Ritter
authors.forename: Steven
authors.initials: S
authors.lastname: Zelenkofske
authors.forename: Albert
authors.initials: A
authors.lastname: Kandra
authors.forename: William L
authors.initials: WL
authors.lastname: Daley
authors.forename: Ricardo
authors.initials: R
authors.lastname: Rocha
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000188:drug therapy*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D013777:Tetrazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014633:Valine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D000959:Antihypertensive Agents; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine