title: Fixed-dose manidipine/delapril versus losartan/hydrochlorothiazide in hypertensive patients with type 2 diabetes and microalbuminuria.
abstract: BACKGROUND
  Patients with diabetes complicated by hypertension and microalbuminuria have elevated cardiovascular risk, and controlling blood pressure in these patients is an urgent clinical priority. The present study aimed to examine the effects of a fixed-dose combination of antihypertensives on blood pressure and microalbuminuria.
  
  
  METHODS
  Patients with type 2 diabetes, mild-to-moderate hypertension (diastolic blood pressure 85-105 mmHg, systolic blood pressure <160 mmHg, and 24-hour mean systolic blood pressure >130 mmHg), and microalbuminuria were randomized to 1 year of doubleblind treatment with fixed-dose manidipine/delapril (n=54) or losartan/hydrochlorothiazide (HCTZ) (n=56).
  
  
  RESULTS
  Blood pressure was significantly reduced at 1 year in both groups (-22.2/-14.6 mmHg and -19.5/-14.3 mmHg, for systolic and diastolic blood pressure respectively, P<0.001 for each), with no significant between-group difference. Reductions in microalbuminuria occurred in both groups, with mean changes at 1 year of -3.9 mg/mmol creatinine (95% CI -5.3, -2.5) for manidipine/delapril (P<0.001 vs. baseline) and -2.7 mg/mmol creatinine (95% CI -4.0, -1.3) for losartan/HCTZ (P<0.001 vs. baseline and P=0.199 between groups). Glycemia over the 1-year study was largely unaffected; the blood glucose concentration was reduced from baseline with manidipine/delapril, although not statistically significant (mean change -0.2 mmol/L, P=0.064). Both treatments were well tolerated, with discontinuation for adverse events for one (1.9%) patient in the manidipine/delapril group and two (3.6%) in the losartan/HCTZ group.
  
  
  CONCLUSIONS
  A fixed-dose manidipine/delapril combination represents a useful addition to the treatment options available to control hypertension complicated by diabetes and microalbuminuria.
authors.affiliation: Kidney and Hypertension Hospital, Federal University of São Paulo, Rua Leandro Dupret 365, São Paulo, 04025-011, Brazil. kohlmann@hrim.com.br
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Kohlmann
authors.forename: Alejandro
authors.initials: A
authors.lastname: Roca-Cusachs
authors.forename: Stéphane
authors.initials: S
authors.lastname: Laurent
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
authors.forename: René R
authors.initials: RR
authors.lastname: Wenzel
authors.forename: Roberto
authors.initials: R
authors.lastname: Fogari