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Clinical Nephrology
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Additive Effect of ACE Inhibition and Angiotensin II Receptor Blockade in Type I Diabetic Patients with Diabetic Nephropathy

Peter Jacobsen, Steen Andersen, Berit R. Jensen and Hans-Henrik Parving
JASN April 2003, 14 (4) 992-999; DOI: https://doi.org/10.1097/01.ASN.0000054495.96193.BF
Peter Jacobsen
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Steen Andersen
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Berit R. Jensen
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Hans-Henrik Parving
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Abstract

ABSTRACT. Albuminuria and hypertension are predictors of poor renal and cardiovascular outcome in diabetic patients. This study tested whether dual blockade of the renin-angiotensin system (RAS) with both an angiotensin-converting enzyme (ACE) inhibitor (ACE-I) and an Angiotensin-II receptor blocker (ARB) is superior to either drug alone in type I diabetic patients with diabetic nephropathy (DN). A randomized double-blind crossover trial was performed with 8-wk treatment with placebo, 20 mg of benazepril once daily, 80 mg of valsartan once daily, and the combination of 20 mg of benazepril and 80 mg of valsartan. Twenty type I diabetic patients with DN were included. At the end of each treatment period, albuminuria, 24-h BP, and GFR were measured. Eighteen patients completed the study. Placebo values were: albuminuria [mean (95% CI)], 701 (490 to 1002) mg/24 h; BP [mean (SEM)], 144 (4)/79 (2) mmHg, and GFR [mean (SEM)], 82 (7) ml/min per 1.73 m2. Treatment with benazepril, valsartan, or dual blockade significantly reduced albuminuria and BP compared with placebo. Benazepril and valsartan were equally effective. Dual blockade induced an additional reduction in albuminuria of 43 % (29 to 54 %) compared with any type of monotherapy, and a reduction in systolic BP of 6 (0 to 13) mmHg and 7 (1 to 14) mmHg (versus benazepril and valsartan, respectively) and a reduction of 7 (4 to 10) mmHg diastolic compared with both monotherapies. GFR was reversibly reduced on dual blockade compared with monotherapy and placebo. All treatments were safe and well tolerated. In conclusion, dual blockade of the RAS may offer additional renal and cardiovascular protection in type I diabetic patients with DN. E-mail: pkjacobsen@dadlnet.dk

  • © 2003 American Society of Nephrology
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Journal of the American Society of Nephrology: 14 (4)
Journal of the American Society of Nephrology
Vol. 14, Issue 4
1 Apr 2003
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Additive Effect of ACE Inhibition and Angiotensin II Receptor Blockade in Type I Diabetic Patients with Diabetic Nephropathy
Peter Jacobsen, Steen Andersen, Berit R. Jensen, Hans-Henrik Parving
JASN Apr 2003, 14 (4) 992-999; DOI: 10.1097/01.ASN.0000054495.96193.BF

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Additive Effect of ACE Inhibition and Angiotensin II Receptor Blockade in Type I Diabetic Patients with Diabetic Nephropathy
Peter Jacobsen, Steen Andersen, Berit R. Jensen, Hans-Henrik Parving
JASN Apr 2003, 14 (4) 992-999; DOI: 10.1097/01.ASN.0000054495.96193.BF
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More in this TOC Section

  • A Randomized, Controlled Trial of Steroids and Cyclophosphamide in Adults with Nephrotic Syndrome Caused by Idiopathic Membranous Nephropathy
  • Lower Progression Rate of End-Stage Renal Disease in Patients with Peripheral Arterial Disease Using Statins or Angiotensin-Converting Enzyme Inhibitors
  • IgACE: A Placebo-Controlled, Randomized Trial of Angiotensin-Converting Enzyme Inhibitors in Children and Young People with IgA Nephropathy and Moderate Proteinuria
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Cited By...

  • Physiology of the Renal Interstitium
  • Potassium Handling with Dual Renin-Angiotensin System Inhibition in Diabetic Nephropathy
  • Recurrence of Secondary Glomerular Disease after Renal Transplantation
  • Effects of Additive Therapy With Spironolactone on Proteinuria in Diabetic Patients Already on ACE Inhibitor or ARB Therapy: Results of a Randomized, Placebo-Controlled, Double-Blind, Crossover Trial
  • Microalbuminuria in Type 2 Diabetes and Hypertension: A marker, treatment target, or innocent bystander?
  • Are Two Better Than One? Angiotensin-Converting Enzyme Inhibitors Plus Angiotensin Receptor Blockers for Reducing Blood Pressure and Proteinuria in Kidney Disease
  • Renoprotection of Optimal Antiproteinuric Doses (ROAD) Study: A Randomized Controlled Study of Benazepril and Losartan in Chronic Renal Insufficiency
  • Albuminuria Is a Target for Renoprotective Therapy Independent from Blood Pressure in Patients with Type 2 Diabetic Nephropathy: Post Hoc Analysis from the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) Trial
  • Dual Blockade of the Renin-Angiotensin System in the Progression of Renal Disease: The Need for More Clinical Trials
  • Progression of Renal Disease: Renoprotective Specificity of Renin-Angiotensin System Blockade
  • ACE Inhibitor or Angiotensin II Receptor Antagonist Attenuates Diabetic Neuropathy in Streptozotocin-Induced Diabetic Rats
  • Systematic Review of Combined Angiotensin-Converting Enzyme Inhibition and Angiotensin Receptor Blockade in Hypertension
  • Long-Term Dual Blockade With Candesartan and Lisinopril in Hypertensive Patients With Diabetes: The CALM II study
  • Recent advances in diabetic nephropathy
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