title: Comparative effect of canrenone or hydrochlorothiazide addition to valsartan/amlodipine combination on urinary albumin excretion in well-controlled type 2 diabetic hypertensive patients with microalbuminuria.
abstract: OBJECTIVE
  To compare the effect of adding canrenone or hydrochlorothiazide (HCTZ) to valsartan/amlodipine combination on urinary albumin excretion (UAE) in microalbuminuric type 2 diabetic hypertensives.
  
  
  METHODS
  After a 2-week placebo period and after 4 weeks of valsartan 160 mg plus amlodipine 5 mg combination, 120 patients whose blood pressure (BP) was not controlled (> 130/80 mmHg) were randomized to canrenone 25 mg or HCTZ 12.5 mg in addition to the previous therapy for 24 weeks. After the first 6 weeks of triple therapy, canrenone or HCTZ doses were doubled in the patients whose BP was yet uncontrolled. At the end of each period (placebo, dual combination and triple combination therapy), clinic and ambulatory BP measurements were recorded and 24 h UAE was evaluated.
  
  
  RESULTS
  Both triple combinations produced greater clinical and ambulatory BP reduction than dual therapy, with no difference between the two groups. UAE was reduced by both regimens, but the decrease associated with canrenone add-on therapy was more pronounced. At week 24, UAE decreased by 45.3% in the canrenone group and by 20.3% in the HCTZ group (p < 0.01).
  
  
  CONCLUSIONS
  These findings indicate that, despite similar BP-lowering effect, the addition of canrenone to valsartan/amlodipine combination was more effective in reducing UAE than HCTZ addition.
authors.affiliation: University of Pavia and Fondazione IRCCS Policlinico San Matteo, Centro per l'Ipertensione e la Fisiopatologia Cardiovascolare, Department of Internal Medicine and Therapeutics , Piazzale Golgi 19, 27100 Pavia , Italy +390382526217 ; +390382526259 ; r.fogari@unipv.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Fogari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Derosa
authors.forename: Annalisa
authors.initials: A
authors.lastname: Zoppi
authors.forename: Pierangelo
authors.initials: P
authors.lastname: Lazzari
authors.forename: Angela
authors.initials: A
authors.lastname: D'Angelo
authors.forename: Amedeo
authors.initials: A
authors.lastname: Mugellini
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000188:drug therapy* / Q000209:etiology / Q000652:urine; D017311:Amlodipine / Q000627:therapeutic use*; D000068838:Amlodipine, Valsartan Drug Combination; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002192:Canrenone / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D004232:Diuretics / Q000627:therapeutic use*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D011446:Prospective Studies; D013777:Tetrazoles / Q000627:therapeutic use*
chemical_list: D000068838:Amlodipine, Valsartan Drug Combination; D000959:Antihypertensive Agents; D004232:Diuretics; D004338:Drug Combinations; D013777:Tetrazoles; D006852:Hydrochlorothiazide; D017311:Amlodipine; D002192:Canrenone