title: Prevention of microalbuminuria in patients with type 2 diabetes and hypertension.
abstract: BACKGROUND
  We have previously demonstrated in the Randomized Olmesartan and Diabetes Microalbuminuria Prevention study that the angiotensin receptor blocker (ARB) olmesartan delays the onset of microalbuminuria in patients with type 2 diabetes. Now, we investigated the effect in the subpopulation with hypertension.
  
  
  METHODS
  Overall, 4020 patients with type 2 diabetes and hypertension at baseline (defined by a SBP/DBP ≥130/80 mmHg or use of antihypertensive medication) received either 40 mg olmesartan once daily or placebo for a median of 3.2 years in a randomized, double-blind, multicenter, controlled trial. Additional antihypertensive drugs (except angiotensin-converting enzyme inhibitors or ARBs) were used as needed to lower blood pressure (BP) to less than 130/80 mmHg.
  
  
  RESULTS
  The average BP was 126.3/74.7 and 129.5/76.6 mmHg, respectively (P < 0.001). Olmesartan delayed the time to onset of microalbuminuria by 25% (hazard ratio = 0.75; 95% confidence interval = 0.61-0.92, P = 0.007). Patients with a baseline SBP above the median of 136.7 mmHg and a SBP reduction above the median of 17.45 mmHg had a lower incidence of microalbuminuria than patients with a SBP reduction of less than 17.45 (8.1 vs. 11.2%, P < 0.0001). Independent from the baseline BP and the degree of BP reduction a 15-39% increase in the time to onset of microalbuminuria was detectable by olmesartan treatment. Cardiovascular events were comparable and occurred in 93 (4.6%) patients taking olmesartan and 86 (4.4%) taking placebo.
  
  
  CONCLUSIONS
  Patients with a better BP reduction are less likely to develop microalbuminuria. Treatment with olmesartan delayed the onset of microalbuminuria independent of the baseline BP and the degree of BP reduction.
authors.affiliation: Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Menne
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Izzo
authors.forename: Sadayoshi
authors.initials: S
authors.lastname: Ito
authors.forename: Andrzej
authors.initials: A
authors.lastname: Januszewicz
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Katayama
authors.forename: Christos
authors.initials: C
authors.lastname: Chatzykirkou
authors.forename: Albert
authors.initials: A
authors.lastname: Mimran
authors.forename: Ton J
authors.initials: TJ
authors.lastname: Rabelink
authors.forename: Eberhard
authors.initials: E
authors.lastname: Ritz
authors.forename: Luis M
authors.initials: LM
authors.lastname: Ruilope
authors.forename: Lars C
authors.initials: LC
authors.lastname: Rump
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Viberti
authors.forename: Hermann
authors.initials: H
authors.lastname: Haller
mesh_terms: D000419:Albuminuria / Q000209:etiology / Q000517:prevention & control*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000652:urine; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000652:urine; D007093:Imidazoles / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D007093:Imidazoles; D013777:Tetrazoles; C437965:olmesartan