بررسي اثر مهار دوگانه سيستم رنين آنژيوتانسين در كنترل پيشرفت نفروپاتي ديابتي در بيماران مبتلا به ديابت تيپ دو

A study on the effect of dual blockade of rennin and angiotensin systems in control of diabetic nephropathy in patients with type 2 diabetic patients

Objective: Proteinuria and hypertension are predictors of poor renal and cardiovascular outcome in diabetic patients. Blockade of the renin-angiotensin system is an established strategy to interfere with progression of renal failure in diabetic patients. Angiotensinconverting enzyme inhibitors (ACEls) and Angiotensin receptor blockers (ARBs) prevent the progression of diabetic nephropathy (ON). Combination of renin-angiotensin system (RAS)inhibiting therapy provides additive benefit in type 1 diabetic patients with diabetic nephropathy. This study tested whether this dual blockade is superior to either drug alone in type 2 diabetic patients with diabetic nephropathy (ON). Subjects and Methods: To assess and compare the effects of enalapril (up to 40 mg/day), losartan (up to 100 mg/day) and combination therapy (enalapril up to 40mg/day plus losartan up to 100mg/day) on urinary protein excretion and renal failure progression. 144 type II diabetic patients with diabetic nephropathy (proteinuria>300mg/14h) and normal or slightly reduced renal function (Cr clearance = 76±42mLlmin) were enrolled in a twelve months, prospective, open, randomized trial. All patients were re-evalated after 2, 6 and 12 months. Results: One hundred and forty four type 2 diabetic patients with ON (88 male and 66 female; mean age: 53±16.31 years) were recruited. Renal function, estimated by creatinine clearance, remained stable throughout the study. Hyperkalemia was more frequent in patients treated with enalapril alone or enalapril plus losartan (P<0.002) than in those on losartan alone. The blood pressure goal «115/75 mm Hg) was achieved by week 8 in all treatment groups (P<0.005 when compared to baseline). Proteinuria decreased significantly in all patients after two months (P