title: Impact of glycaemic control on the effect of direct renin inhibition in the AVOID study.
abstract: BACKGROUND
  Hyperglycaemia induces development and progression of microvascular complications in diabetes. A direct link between high glucose levels and intrarenal renin-angiotensin activation has been demonstrated. This post-hoc analysis assessed the influence of baseline glycaemic control on the reduction of albuminuria with aliskiren or placebo added to losartan in the Aliskiren in the EValuation of PrOteinuria In Diabetes (AVOID) study.
  
  
  METHODS
  In AVOID, 599 patients with type 2 diabetes, hypertension and nephropathy received 6 months' aliskiren or placebo added to losartan 100 mg and optimal antihypertensive therapy. Changes in urinary albumin creatinine ratio at end of study were assessed by tertiles of baseline HbA(1c) levels.
  
  
  RESULTS
  Patients were divided into tertiles of HbA(1c) (<7.1%, 7.1 to <8.4% and ≥8.4%). There were no differences between tertiles, except patients in the highest tertile group more frequently used insulin. The antiproteinuric effect of aliskiren was consistent across tertiles, with the largest effect in the highest tertile (HbA(1c) ≥8.4%).
  
  
  CONCLUSIONS
  This post-hoc analysis of the AVOID study suggests that renin inhibition with aliskiren 300 mg once daily added to losartan 100 mg once daily plus optimal antihypertensive therapy provides reductions in urinary albumin creatinine ratio that are efficacious in all, but particularly in poorly controlled, diabetic patients.
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark. frip@steno.dk
authors.forename: Frederik
authors.initials: F
authors.lastname: Persson
authors.forename: Julia B
authors.initials: JB
authors.lastname: Lewis
authors.forename: Edmund J
authors.initials: EJ
authors.lastname: Lewis
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
authors.forename: Norman K
authors.initials: NK
authors.lastname: Hollenberg
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Parving
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000494:pharmacology / Q000627:therapeutic use*; D015992:Body Mass Index; D048909:Diabetes Complications / Q000188:drug therapy*; D005260:Female; D005650:Fumarates / Q000494:pharmacology / Q000627:therapeutic use*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006306:Health Surveys; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010919:Placebos; D011507:Proteinuria / Q000150:complications / Q000188:drug therapy*; D012083:Renin / Q000378:metabolism; D055815:Young Adult; D000092502:Renin Inhibitors
chemical_list: D000577:Amides; D005650:Fumarates; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D010919:Placebos; D012083:Renin; D000092502:Renin Inhibitors; C446481:aliskiren