BACKGROUND AND OBJECTIVES: Elevated BP contributes to development and progression of proteinuria and decline in renal function in patients with type 2 diabetes. Our post hoc analysis assessed the baseline BP influence on the antiproteinuric effect in the Aliskiren in the Evaluation of Proteinuria in Diabetes (AVOID) study. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In the AVOID study, 599 hypertensive type 2 diabetic patients with nephropathy received 6 months of aliskiren (150 mg force titrated to 300 mg daily after 3 months) or placebo added to losartan (100 mg) daily and optimal antihypertensive therapy. Changes in early morning urinary albumin:creatinine ratio and eGFR at week 24 were assessed by subgroups of baseline BP: Group A (prespecified target), <130/80 mmHg (n=159); Group B, <140/90 mmHg but ≥130/80 mmHg (n=189); and Group C (insufficient BP control), ≥140/90 mmHg (n=251). RESULTS:Mean baseline BP (mmHg) levels for Groups A, B, and C were 120/71, 133/78, and 145/81, respectively. BP during the trial was nearly identical to baseline levels in all groups. The antiproteinuric effects of aliskiren were consistent across subgroups of baseline BP (19 to 22% reduction versus placebo). In Group C, the decline in eGFR was significantly lower with aliskiren than with placebo (P=0.013). CONCLUSIONS:Aliskiren (300 mg) added to losartan (100 mg) plus optimal antihypertensive therapy provides antiproteinuric effects independent of BP in patients with type 2 diabetes and nephropathy. Renal function was better preserved with aliskiren in patients with insufficient BP control.
RCT Entities:
BACKGROUND AND OBJECTIVES: Elevated BP contributes to development and progression of proteinuria and decline in renal function in patients with type 2 diabetes. Our post hoc analysis assessed the baseline BP influence on the antiproteinuric effect in the Aliskiren in the Evaluation of Proteinuria in Diabetes (AVOID) study. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In the AVOID study, 599 hypertensive type 2 diabeticpatients with nephropathy received 6 months of aliskiren (150 mg force titrated to 300 mg daily after 3 months) or placebo added to losartan (100 mg) daily and optimal antihypertensive therapy. Changes in early morning urinary albumin:creatinine ratio and eGFR at week 24 were assessed by subgroups of baseline BP: Group A (prespecified target), <130/80 mmHg (n=159); Group B, <140/90 mmHg but ≥130/80 mmHg (n=189); and Group C (insufficientBP control), ≥140/90 mmHg (n=251). RESULTS: Mean baseline BP (mmHg) levels for Groups A, B, and C were 120/71, 133/78, and 145/81, respectively. BP during the trial was nearly identical to baseline levels in all groups. The antiproteinuric effects of aliskiren were consistent across subgroups of baseline BP (19 to 22% reduction versus placebo). In Group C, the decline in eGFR was significantly lower with aliskiren than with placebo (P=0.013). CONCLUSIONS:Aliskiren (300 mg) added to losartan (100 mg) plus optimal antihypertensive therapy provides antiproteinuric effects independent of BP in patients with type 2 diabetes and nephropathy. Renal function was better preserved with aliskiren in patients with insufficientBP control.
Authors: C L Rohlfing; R R Little; H M Wiedmeyer; J D England; R Madsen; M I Harris; K M Flegal; M S Eberhardt; D E Goldstein Journal: Diabetes Care Date: 2000-02 Impact factor: 19.112
Authors: Roland E Schmieder; Johannes F E Mann; Helmut Schumacher; Peggy Gao; Giuseppe Mancia; Michael A Weber; Matthew McQueen; Teo Koon; Salim Yusuf Journal: J Am Soc Nephrol Date: 2011-06-30 Impact factor: 10.121
Authors: R G Langham; D J Kelly; A J Cox; N M Thomson; H Holthöfer; P Zaoui; N Pinel; D J Cordonnier; R E Gilbert Journal: Diabetologia Date: 2002-09-25 Impact factor: 10.122
Authors: George L Bakris; Matthew R Weir; Shahnaz Shanifar; Zhongxin Zhang; Janice Douglas; David J van Dijk; Barry M Brenner Journal: Arch Intern Med Date: 2003-07-14
Authors: Dick de Zeeuw; Giuseppe Remuzzi; Hans-Henrik Parving; William F Keane; Zhongxin Zhang; Shahnaz Shahinfar; Steve Snapinn; Mark E Cooper; William E Mitch; Barry M Brenner Journal: Kidney Int Date: 2004-06 Impact factor: 10.612
Authors: Kasper Rossing; Per K Christensen; Peter Hovind; Lise Tarnow; Peter Rossing; Hans-Henrik Parving Journal: Kidney Int Date: 2004-10 Impact factor: 10.612
Authors: Dick de Zeeuw; Giuseppe Remuzzi; Hans-Henrik Parving; William F Keane; Zhongxin Zhang; Shahnaz Shahinfar; Steve Snapinn; Mark E Cooper; William E Mitch; Barry M Brenner Journal: Circulation Date: 2004-08-09 Impact factor: 29.690