title: Renin-angiotensin-aldosterone system blockade and urinary albumin excretion in community-based patients with Type 2 diabetes: the Fremantle Diabetes Study.
abstract: OBJECTIVE
  To determine whether the reduction in urinary albumin excretion through renin-angiotensin-aldosterone system blockade found in intervention trials extends to community-based patients with Type 2 diabetes.
  
  
  METHODS
  We analysed data from 302 participants in the longitudinal observational Fremantle Diabetes Study who commenced angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy during follow-up and who had an annual assessment on either side of this therapeutic change.
  
  
  RESULTS
  At baseline, the patients had a mean age of 63.8 years, a median diabetes duration of 4 years, a median HbA(1c) of 7.6% (60 mmol/mol) and a geometric mean (sd range) urinary albumin:creatinine ratio of 3.3 mg/mmol (0.8-13.1 mg/mmol). The percentages with normo-, micro- and macroalbuminuria were 49.0, 38.4 and 12.6%, respectively. During 6.1 ± 1.7 years of follow-up, initiation of renin-angiotensin-aldosterone system blockade was associated with a larger geometric mean (sd range) absolute albumin:creatinine ratio reduction in the patients with macroalbuminuria compared with those who had either normo- or microalbuminuria [-40.9 (-825.7 to 159.9) mg/mmol) vs. 1.7 (-1.6 to 20.0) mg/mmol and -0.5 (-23.0 to 39.5) mg/mmol, respectively; P < 0.001]. These changes remained significant after adjustment for changes in blood pressure and other potentially confounding variables, including drug dose and angiotensin-converting enzyme genotype. The post-treatment median albumin:creatinine ratios were 35.4 and 27.4% lower than before treatment in those with micro- or macroalbuminuria, respectively.
  
  
  CONCLUSIONS
  Usual-care initiation of renin-angiotensin-aldosterone system blockade confers a quantitatively similar renal benefit to that in intervention trials in Type 2 diabetes.
authors.affiliation: Department of Diabetes and Endocrinology, PathWest, Nedlands, WA, Australia.
authors.forename: P G
authors.initials: PG
authors.lastname: Fegan
authors.forename: W A
authors.initials: WA
authors.lastname: Davis
authors.forename: N
authors.initials: N
authors.lastname: Kamber
authors.forename: S
authors.initials: S
authors.lastname: Sivakumar
authors.forename: J
authors.initials: J
authors.lastname: Beilby
authors.forename: T M E
authors.initials: TM
authors.lastname: Davis
mesh_terms: D000419:Albuminuria / Q000378:metabolism*; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism / Q000652:urine; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000378:metabolism / Q000652:urine; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012084:Renin-Angiotensin System / Q000187:drug effects*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents