Renal function, glycemic control and perindopril in diabetic patients.

We studied the effect of perindopril, administered for a period of 9 months, on renal function, albuminuria and glycemic control of diabetic subjects with mild-to-moderate hypertension. After 1 month of placebo, 40 insulin-treated patients were divided into 3 groups based on the level of albuminuria. Group I had normal albuminuria (less than 15 mg/24 hr), group II had pathological microalbuminuria (15-150 mg/24 hr) and group III had macroproteinuria (greater than 150 mg/24 hr). They were given perindopril (4 or 8 mg) once daily. Diastolic blood pressure was normalized within the first 3 months in 80% of the patients. Twenty-nine of these patients (13, 9 and 7 from groups I, II and III, respectively) were followed for a total treatment period of 9 months. They were matched for age, duration of diabetes and hypertension, daily insulin dose, systolic and diastolic blood pressures and quality of glycemic control. Diastolic blood pressure was decreased by 14 and 17% at 1 and 9 months, respectively. Heart rate was not significantly modified. At 3 months, the angiotensin converting enzyme activity was markedly inhibited, while plasma renin activity was increased. In patients in group II, microalbuminuria was reduced from 59 +/- 13 to 32 +/- 6 mg/24 hr after 1 month and this effect was maintained at 9 months. Despite similar decreases in blood pressure, no significant change in the albumin excretion rate was observed in patients in groups I and III. Creatinine clearance remained stable and glycemic control did not change throughout the study in the 3 groups. We conclude that perindopril normalizes blood pressure in a large majority of hypertensive diabetic patients without affecting the quality of diabetes control. It also induces a marked and sustained reduction in microalbuminuria in patients at risk of developing diabetic nephropathy.

RCT Entities:   Population Interventions Outcomes