Skip to main content
PMC home page
The BMJ logoLink to The BMJ
. 1990 Apr 7;300(6729):904–907. doi: 10.1136/bmj.300.6729.904

Contrasting effects of enalapril and metoprolol on proteinuria in diabetic nephropathy.

S Björck 1, H Mulec 1, S A Johnsen 1, G Nyberg 1, M Aurell 1
PMCID: PMC1662674  PMID: 2337713

Abstract

OBJECTIVE--To assess whether angiotensin converting enzyme inhibition reduces proteinuria in diabetic nephropathy more than blood pressure reduction with other antihypertensive treatment. DESIGN--Prospective, open randomised study lasting eight weeks in patients with diabetic nephropathy. SETTING--Outpatient nephrology clinics. PATIENTS--40 Patients with type I diabetes and diabetic nephropathy with reduced renal function. INTERVENTION--Antihypertensive treatment with enalapril or metoprolol, usually combined with frusemide. MAIN OUTCOME MEASURES--Arterial blood pressure and urinary excretion of albumin and protein. RESULTS--Arterial blood pressure after eight weeks was 135/82 (SD 13/7) mm Hg in the group given enalapril and 136/86 (16/12) mm Hg in the group given metoprolol. Proteinuria and albuminuria were similar in both groups before randomisation. After eight weeks' treatment, the geometric mean albumin excretion was 0.7 (95% confidence interval 0.5 to 1.2) g/24 h in the patients given enalapril and 1.6 (1.1 to 2.5) g/24 h in the patients given metoprolol (p less than 0.02). The proteinuria was 1.1 (0.7 to 1.7) and 2.4 (1.6 to 3.6) g/24 h respectively (p less than 0.02). CONCLUSIONS--Antihypertensive treatment with enalapril reduced proteinuria in patients with diabetic nephropathy more than an equally effective antihypertensive treatment with metoprolol. This points to a specific antiproteinuric effect of the angiotensin converting enzyme inhibitor independent of the effect on systemic blood pressure.

Full text

PDF
907

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baba T., Murabayashi S., Takebe K. Comparison of the renal effects of angiotensin converting enzyme inhibitor and calcium antagonist in hypertensive type 2 (non-insulin-dependent) diabetic patients with microalbuminuria: a randomised controlled trial. Diabetologia. 1989 Jan;32(1):40–44. doi: 10.1007/BF00265402. [DOI] [PubMed] [Google Scholar]
  2. Björck S., Delin K., Herlitz H., Larsson O., Aurell M. Renin secretion in advanced diabetic nephropathy. Scand J Urol Nephrol Suppl. 1984;79:53–57. [PubMed] [Google Scholar]
  3. Borch-Johnsen K., Andersen P. K., Deckert T. The effect of proteinuria on relative mortality in type 1 (insulin-dependent) diabetes mellitus. Diabetologia. 1985 Aug;28(8):590–596. doi: 10.1007/BF00281993. [DOI] [PubMed] [Google Scholar]
  4. D'Angelo A., Sartori L., Gambaro G., Giannini S., Malvasi L., Benetollo P., Lavagnini T., Crepaldi G. Captopril in the treatment of hypertension in type I and type II diabetic patients. Postgrad Med J. 1986;62 (Suppl 1):69–72. [PubMed] [Google Scholar]
  5. Granerus G., Aurell M. Reference values for 51Cr-EDTA clearance as a measure of glomerular filtration rate. Scand J Clin Lab Invest. 1981 Oct;41(6):611–616. doi: 10.3109/00365518109090505. [DOI] [PubMed] [Google Scholar]
  6. Heeg J. E., de Jong P. E., van der Hem G. K., de Zeeuw D. Efficacy and variability of the antiproteinuric effect of ACE inhibition by lisinopril. Kidney Int. 1989 Aug;36(2):272–279. doi: 10.1038/ki.1989.190. [DOI] [PubMed] [Google Scholar]
  7. Hommel E., Mathiesen E., Edsberg B., Bahnsen M., Parving H. H. Acute reduction of arterial blood pressure reduces urinary albumin excretion in type 1 (insulin-dependent) diabetic patients with incipient nephropathy. Diabetologia. 1986 Apr;29(4):211–215. doi: 10.1007/BF00454877. [DOI] [PubMed] [Google Scholar]
  8. Hommel E., Parving H. H., Mathiesen E., Edsberg B., Damkjaer Nielsen M., Giese J. Effect of captopril on kidney function in insulin-dependent diabetic patients with nephropathy. Br Med J (Clin Res Ed) 1986 Aug 23;293(6545):467–470. doi: 10.1136/bmj.293.6545.467. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Ikeda I., Iinuma K., Takai M., Yanagawa Y., Kurata K., Ogihara T., Kumahara Y. Measurement of plasma renin activity by a simple solid phase radioimmunoassay. J Clin Endocrinol Metab. 1982 Feb;54(2):423–428. doi: 10.1210/jcem-54-2-423. [DOI] [PubMed] [Google Scholar]
  10. Insua A., Ribstein J., Mimran A. Comparative effect of captopril and nifedipine in normotensive patients with incipient diabetic nephropathy. Postgrad Med J. 1988;64 (Suppl 3):59–92. [PubMed] [Google Scholar]
  11. Klahr S., Schreiner G., Ichikawa I. The progression of renal disease. N Engl J Med. 1988 Jun 23;318(25):1657–1666. doi: 10.1056/NEJM198806233182505. [DOI] [PubMed] [Google Scholar]
  12. Marre M., Leblanc H., Suarez L., Guyenne T. T., Ménard J., Passa P. Converting enzyme inhibition and kidney function in normotensive diabetic patients with persistent microalbuminuria. Br Med J (Clin Res Ed) 1987 Jun 6;294(6585):1448–1452. doi: 10.1136/bmj.294.6585.1448. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Mogensen C. E. Progression of nephropathy in long-term diabetics with proteinuria and effect of initial anti-hypertensive treatment. Scand J Clin Lab Invest. 1976 Jul;36(4):383–388. doi: 10.1080/00365517609055274. [DOI] [PubMed] [Google Scholar]
  14. Parving H. H., Andersen A. R., Smidt U. M., Hommel E., Mathiesen E. R., Svendsen P. A. Effect of antihypertensive treatment on kidney function in diabetic nephropathy. Br Med J (Clin Res Ed) 1987 Jun 6;294(6585):1443–1447. doi: 10.1136/bmj.294.6585.1443. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Parving H. H., Hommel E., Smidt U. M. Protection of kidney function and decrease in albuminuria by captopril in insulin dependent diabetics with nephropathy. BMJ. 1988 Oct 29;297(6656):1086–1091. doi: 10.1136/bmj.297.6656.1086. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Passa P., LeBlanc H., Marre M. Effects of enalapril in insulin-dependent diabetic subjects with mild to moderate uncomplicated hypertension. Diabetes Care. 1987 Mar-Apr;10(2):200–204. doi: 10.2337/diacare.10.2.200. [DOI] [PubMed] [Google Scholar]
  17. Romanelli G., Giustina A., Cimino A., Valentini U., Agabiti-Rosei E., Muiesan G., Giustina G. Short term effect of captopril on microalbuminuria induced by exercise in normotensive diabetics. BMJ. 1989 Feb 4;298(6669):284–288. doi: 10.1136/bmj.298.6669.284. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Taguma Y., Kitamoto Y., Futaki G., Ueda H., Monma H., Ishizaki M., Takahashi H., Sekino H., Sasaki Y. Effect of captopril on heavy proteinuria in azotemic diabetics. N Engl J Med. 1985 Dec 26;313(26):1617–1620. doi: 10.1056/NEJM198512263132601. [DOI] [PubMed] [Google Scholar]
  19. Valvo E., Bedogna V., Casagrande P., Antiga L., Zamboni M., Bommartini F., Oldrizzi L., Rugiu C., Maschio G. Captopril in patients with type II diabetes and renal insufficiency: systemic and renal hemodynamic alterations. Am J Med. 1988 Sep;85(3):344–348. doi: 10.1016/0002-9343(88)90584-0. [DOI] [PubMed] [Google Scholar]
  20. Winocour P. H., Waldek S., Anderson D. C. Converting enzyme inhibition and kidney function in normotensive diabetic patients with persistent microalbuminuria. Br Med J (Clin Res Ed) 1987 Aug 8;295(6594):391–391. doi: 10.1136/bmj.295.6594.391. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. de Châtel R., Weidmann P., Flammer J., Ziegler W. H., Beretta-Piccoli C., Vetter W., Reubi F. C. Sodium, renin, aldosterone, catecholamines, and blood pressure in diabetes mellitus. Kidney Int. 1977 Dec;12(6):412–421. doi: 10.1038/ki.1977.132. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES