Portal de Periódicos da CAPES

Effect of Losartan on Microalbuminuria in Normotensive Patients with Type 2 Diabetes Mellitus

2003; American College of Physicians; Volume: 139; Issue: 2 Linguagem: Inglês

10.7326/0003-4819-139-2-200307150-00008

1539-3704

Adrienne A.M. Zandbergen, M.G.A. Baggen, Steven W. J. Lamberts, Aart H. Bootsma, Dick de Zeeuw, Rob J. Ouwendijk,

Hormonal and reproductive studies

Background: Angiotensin-converting enzyme inhibitors have shown antiproteinuric effects in normotensive and hypertensive diabetic patients. Angiotensin-receptor antagonists reduce urinary albumin excretion and the risk for renal and cardiovascular complications in hypertensive patients with type 2 diabetes mellitus. The effect of angiotensin-receptor antagonists in normotensive diabetic patients with microalbuminuria has not yet been reported. Objective: To assess the antiproteinuric effects of losartan in normotensive patients with type 2 diabetes and microalbuminuria. Design: Multicenter randomized, double-blind, placebo-controlled clinical trial. Setting: 19 outpatient clinics in the Netherlands. Patients: 147 normotensive patients with type 2 diabetes mellitus and microalbuminuria. Intervention: 74 patients were randomly assigned to receive losartan and 73 patients were assigned to receive placebo for 10 weeks; 71 patients in each group completed the study. The losartan dose was 50 mg during the first 5 weeks and 100 mg during the subsequent 5 weeks. Measurements: Change in urinary albumin excretion rate after 5 and 10 weeks, change in creatinine clearance and blood pressure, and safety and tolerability of losartan. Results: A significant 25% relative reduction in the albumin excretion rate occurred after 5 weeks of the 50-mg losartan dose, with further improvement over the subsequent 5 weeks with the 100-mg dose (relative reduction, 34%). In the losartan group, creatinine clearance did not improve and blood pressure decreased slightly. Side effects did not differ between treatment groups. Conclusions: The angiotensin-receptor antagonist losartan reduces urinary albumin excretion in normotensive patients with type 2 diabetes and microalbuminuria. In multivariate analysis, the antiproteinuric effect of losartan was independent of the associated reduction in blood pressure. Losartan was safe and well tolerated in these normotensive patients.