Article Figures & Data
Figures
Figure 1. Albuminuria and BP after blockade of the renin-angiotensin system (RAS) in 18 type 1 diabetic patients with diabetic nephropathy. Albuminuria levels are geometric mean with 95% CI; BP levels are mean with SEM.
Figure 2. Individual changes in albuminuria as response to blockade of the RAS in type 1 diabetic patients with diabetic nephropathy.
Figure 3. Correlations between treatment response on benazepril and dual blockade of the RAS in type 1 diabetic patients with diabetic nephropathy.
Figure 4. Evaluation of carryover effects of treatments on change in albuminuria. Patients receiving placebo treatment in the initial period (—) compared with patients treated with active compounds in the first period (X). Levels are medians, and bars represent range. NS within all treatments.
Tables
Table 1. Baseline clinical data before start of study medicationa
a Mean (SD). b Median (range). Furosemide, in addition to study medication, was the only drug kept throughout the study. Age (yr) 43 (7) Gender (M/F) 13/5 Duration of diabetes (yr) 30 (7) Duration of diabetic nephropathy (yr) 10 (6) Retinopathy (background/proliferative) 6/12 Smokers (no/yes) 12/6 Office BP (mmHg) 141 (15)/81 (6) Albuminuria (mg/24 h)b 362 (80–2628) No. of antihypertensive agentsb 2 (2–3) Previous treatment with ACE-I/ARB (yes/no) 18/0 Dose of furosemide (mg/d)b 40 (20–250) Table 2. Effects on kidney function and arterial BP of blockade of the renin angiotensin system in 18 type I diabetic patients with diabetic nephropathy
Parameter Placebo Values Decline from Placebo Benazepril 20 mg Valsartan 80 mg Benazepril 20 mg + Valsartan 80 mg Placebo values are mean (SEM) and changes are mean (95% CI). a Geometric mean (95% CI); b P < 0.001 versus placebo; c P < 0.05 versus placebo; d P < 0.01 dual blockade versus mono-therapy; e P < 0.05 dual blockade versus mono-therapy. Albuminuria 701 (490 to 1002) mg/24 ha 65 (56 to 72)%b 65 (56 to 72)%b 80 (75 to 84)%bd GFR (ml/min per 1.73 m2) 82 (7) 3 (−1 to 7) 4 (−1 to 8) 10 (6 to 14)bd P-creatinine (μmol/L) 115 (7) −1 (−8 to 6) 2 (−5 to 9) −9 (−16 to −2)ce Albuminuria/([p-albumin] × [GFR]) 172 (109 to 270) 10−6a 65 (57 to 72)%b 64 (55 to 71)%b 78 (73 to 82)%bd 24-h systolic BP (mmHg) 144 (4) 15 (9 to 22)b 15 (8 to 21)b 22 (15 to 28)b day (7 to 23) 149 (3) 15 (8 to 21)b 15 (9 21)b 22 (15 to 28)be night (23 to 7) 133 (4) 16 (7 to 25)b 13 (5 to 22)c 21 (13 to 30)b 24-h diastolic BP (mmHg) 79 (2) 6 (3 to 9)b 6 (3 to 9)b 13 (10 to 16)bd day (7 to 23) 82 (2) 7 (4 to 10)b 7 (4 to 10)b 14 (11 to 17)bd night (23 to 7) 72 (2) 5 (1 to 9)c 4 (0 to 8) 11 (7 to 15)bd Table 3. Effects on laboratory parameters of blockade of the renin angiotensin system in 18 type I diabetic patients with diabetic nephropathy
Parameter Placebo Benazepril 20 mg Valsartan 80 mg Benazepril 20 mg + Valsartan 80 mg Values are mean (SEM) and a geometric mean (95% CI). b P < 0.05 versus placebo; c P < 0.01 dual blockade versus mono-therapy; d P < 0.05 dual blockade versus mono-therapy; e P < 0.05 dual blockade versus benazepril. Renina (mU/L) 30 (18 to 50) 161 (72 to 364)b 163 (82 to 325)b 331 (133 to 823)bc Angiotensin IIa (pmol/L) 13 (9 to 17) 7 (5 to 10)b 44 (26 to 75)b 11 (6 to 21)d P-potassium (mmol/L) 3.7 (0.1) 4.0 (0.2)b 3.9 (0.1) 4.3 (0.1)bc Hemoglobin (mmol/L) 8.5 (0.3) 8.2 (0.2)b 8.1 (0.2)b 7.8 (0.2)be Hemoglobin A1c (%) 9.1 (0.2) 9.5 (0.2) 9.2 (0.2) 9.6 (0.2)b P-cholesterol (mmol/L) 5.5 (0.3) 5.3 (0.3) 4.9 (0.2)b 4.8 (0.2)be P-HDL (mmol/L) 1.5 (0.1) 1.5 (0.1) 1.5 (0.1) 1.4 (0.1) P-LDL (mmol/L) 3.4 (0.2) 3.3 (0.2) 2.9 (0.1)b 2.7 (0.2)be P-triglyceride (mmol/L) 1.3 (0.2) 1.2 (0.2) 1.1 (0.1) 1.3 (0.2) U-sodium excretion (mmol/24 h) 194 (17) 204 (16) 187 (13) 195 (17)
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