Captopril reduces the risk of nephropathy in IDDM patients with microalbuminuria

G. Boner; D. J. Van Dyk; M. H. Tan; J. Tan; A. Ekstrand; V. A. Koivisto; L. C. Groop; P. H. Groop; A. Lucas; R. Romero; I. Salinas; A. Sanmarti; F. Escobar; F. Escobar-Jimenez; M. M. Campos-Pastor; M. Mugoz; M. Gomez; R. Mangili; G. Pozza; D. Spotti; K. Wurgler Hansen; J. Sandahl Christiansen; F. Klein; C. E. Mogensen; L. G. Van Doorn; P. F M J Spooren; J. K. Cruickshank; J. Jervell; P. N. Paus; D. J. Barnes; A. Collins; G. C. Viberti; G. Williams; G. A. Nelstrop; L. Amorosa; J. R. Anolik; S. L. Aronoff; B. Eubank; M. Bailie; L. Pelletier; T. Blevins; M. A. Charles; M. Perry; D. Clarke; D. Tomkey; D. Einhorn; D. Humphries; A. J. Garber; B. Haag; E. Williams; W. Hoy; M. Watkins; D. Kahkonen; D. Kruger; C. Kilo; L. Laffel; E. Golden; P. Lodewick; Lovinsky; J. Mason; S. Johnson; J. McGill; L. Schmidt; P. Orlander; K. Sorenson; Philip Raskin; D. Hellenbrand; S. Rosenblatt; S. Schwartz; J. Aufieri; J. P. Sheehan; M. Ulchaker; J. S. Skyler; R. Agramonte; J. Starr; D. Gagliastre; T. Taylor; K. Dawn; W. K. Ward; M. Rigdon

doi:10.1007/BF00403306

Captopril reduces the risk of nephropathy in IDDM patients with microalbuminuria

G. Boner, D. J. Van Dyk, M. H. Tan, J. Tan, A. Ekstrand, V. A. Koivisto, L. C. Groop, P. H. Groop, A. Lucas, R. Romero, I. Salinas, A. Sanmarti, F. Escobar, F. Escobar-Jimenez, M. M. Campos-Pastor, M. Mugoz, M. Gomez, R. Mangili, G. Pozza, D. SpottiK. Wurgler Hansen, J. Sandahl Christiansen, F. Klein, C. E. Mogensen, L. G. Van Doorn, P. F M J Spooren, J. K. Cruickshank, J. Jervell, P. N. Paus, D. J. Barnes, A. Collins, G. C. Viberti, G. Williams, G. A. Nelstrop, L. Amorosa, J. R. Anolik, S. L. Aronoff, B. Eubank, M. Bailie, L. Pelletier, T. Blevins, M. A. Charles, M. Perry, D. Clarke, D. Tomkey, D. Einhorn, D. Humphries, A. J. Garber, B. Haag, E. Williams, W. Hoy, M. Watkins, D. Kahkonen, D. Kruger, C. Kilo, L. Laffel, E. Golden, P. Lodewick, Lovinsky, J. Mason, S. Johnson, J. McGill, L. Schmidt, P. Orlander, K. Sorenson, Philip Raskin, D. Hellenbrand, S. Rosenblatt, S. Schwartz, J. Aufieri, J. P. Sheehan, M. Ulchaker, J. S. Skyler, R. Agramonte, J. Starr, D. Gagliastre, T. Taylor, K. Dawn, W. K. Ward, M. Rigdon

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Abstract

In insulin-dependent diabetes mellitus (IDDM), microalbuminuria predicts renal and cardiovascular disease. We report a combined analysis of 235 normotensive IDDM patients with microalbuminuria who participated in two 24-month double-blind, randomised, placebo-controlled trials to assess the effects of captopril 50 mg twice daily on the progression to overt clinical albuminuria. Of the 225 patients who were evaluable on an intent to treat basis, 25 of 114 placebo-treated patients (21.9%) and 8 of 111 captopril-treated patients (7.2%) progressed to persistent clinical albuminuria. The risk of progression over 24 months was significantly reduced by captopril (p = 0.004) with a risk reduction of 69.2% (95% confidence interval (CI): 31.7 to 86.1%). This degree of risk reduction remained at the same level (62.9% [16.1-83.6%], p = 0.017) after adjustment for differences in time-varying mean arterial blood pressure. Albumin excretion rate increased by an average of 14.2% [3.1-26.5%] per year in the placebo-treated group compared with a reduction of 9.6% [-18.6-0.4%] per year in the captopril-treated group (p = 0.002). The rate of fall of creatinine clearance tended to be faster in the placebo-treated group than in the captopril treated group (-6.4 [-10.2--2.5] vs -1.4 [-5.3-2.6] ml · min^-1 · 1.73 m^-2, p = 0.07). Baseline albumin excretion rate (p < 0.0001) and glycated haemoglobin (p = 0.03) were independent predictors of progression to clinical albuminuria and changes in mean arterial blood pressure (p = 0.02) and serum cholesterol level (p = 0.003) were significantly associated with percentage changes in albumin excretion rate. Captopril reduces the risk of progression to overt nephropathy in IDDM patients with microalbuminuria, an effect partly independent of its blood pressure-lowering effects.

Original language	English (US)
Pages (from-to)	587-593
Number of pages	7
Journal	Diabetologia
Volume	39
Issue number	5
DOIs	https://doi.org/10.1007/BF00403306
State	Published - 1996

Keywords

angiotensin converting enzyme inhibition
diabetic nephropathy
insulin-dependent diabetes mellitus
microalbuminuria

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism

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10.1007/BF00403306

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Boner, G., Van Dyk, D. J., Tan, M. H., Tan, J., Ekstrand, A., Koivisto, V. A., Groop, L. C., Groop, P. H., Lucas, A., Romero, R., Salinas, I., Sanmarti, A., Escobar, F., Escobar-Jimenez, F., Campos-Pastor, M. M., Mugoz, M., Gomez, M., Mangili, R., Pozza, G., ... Rigdon, M. (1996). Captopril reduces the risk of nephropathy in IDDM patients with microalbuminuria. Diabetologia, 39(5), 587-593. https://doi.org/10.1007/BF00403306

Boner, G, Van Dyk, DJ, Tan, MH, Tan, J, Ekstrand, A, Koivisto, VA, Groop, LC, Groop, PH, Lucas, A, Romero, R, Salinas, I, Sanmarti, A, Escobar, F, Escobar-Jimenez, F, Campos-Pastor, MM, Mugoz, M, Gomez, M, Mangili, R, Pozza, G, Spotti, D, Hansen, KW, Christiansen, JS, Klein, F, Mogensen, CE, Van Doorn, LG, Spooren, PFMJ, Cruickshank, JK, Jervell, J, Paus, PN, Barnes, DJ, Collins, A, Viberti, GC, Williams, G, Nelstrop, GA, Amorosa, L, Anolik, JR, Aronoff, SL, Eubank, B, Bailie, M, Pelletier, L, Blevins, T, Charles, MA, Perry, M, Clarke, D, Tomkey, D, Einhorn, D, Humphries, D, Garber, AJ, Haag, B, Williams, E, Hoy, W, Watkins, M, Kahkonen, D, Kruger, D, Kilo, C, Laffel, L, Golden, E, Lodewick, P, Lovinsky, Mason, J, Johnson, S, McGill, J, Schmidt, L, Orlander, P, Sorenson, K, Raskin, P, Hellenbrand, D, Rosenblatt, S, Schwartz, S, Aufieri, J, Sheehan, JP, Ulchaker, M, Skyler, JS, Agramonte, R, Starr, J, Gagliastre, D, Taylor, T, Dawn, K, Ward, WK & Rigdon, M 1996, 'Captopril reduces the risk of nephropathy in IDDM patients with microalbuminuria', Diabetologia, vol. 39, no. 5, pp. 587-593. https://doi.org/10.1007/BF00403306

@article{dd580cce77d4465d904a80178f27bdaf,

title = "Captopril reduces the risk of nephropathy in IDDM patients with microalbuminuria",

abstract = "In insulin-dependent diabetes mellitus (IDDM), microalbuminuria predicts renal and cardiovascular disease. We report a combined analysis of 235 normotensive IDDM patients with microalbuminuria who participated in two 24-month double-blind, randomised, placebo-controlled trials to assess the effects of captopril 50 mg twice daily on the progression to overt clinical albuminuria. Of the 225 patients who were evaluable on an intent to treat basis, 25 of 114 placebo-treated patients (21.9%) and 8 of 111 captopril-treated patients (7.2%) progressed to persistent clinical albuminuria. The risk of progression over 24 months was significantly reduced by captopril (p = 0.004) with a risk reduction of 69.2% (95% confidence interval (CI): 31.7 to 86.1%). This degree of risk reduction remained at the same level (62.9% [16.1-83.6%], p = 0.017) after adjustment for differences in time-varying mean arterial blood pressure. Albumin excretion rate increased by an average of 14.2% [3.1-26.5%] per year in the placebo-treated group compared with a reduction of 9.6% [-18.6-0.4%] per year in the captopril-treated group (p = 0.002). The rate of fall of creatinine clearance tended to be faster in the placebo-treated group than in the captopril treated group (-6.4 [-10.2--2.5] vs -1.4 [-5.3-2.6] ml · min-1 · 1.73 m-2, p = 0.07). Baseline albumin excretion rate (p < 0.0001) and glycated haemoglobin (p = 0.03) were independent predictors of progression to clinical albuminuria and changes in mean arterial blood pressure (p = 0.02) and serum cholesterol level (p = 0.003) were significantly associated with percentage changes in albumin excretion rate. Captopril reduces the risk of progression to overt nephropathy in IDDM patients with microalbuminuria, an effect partly independent of its blood pressure-lowering effects.",

keywords = "angiotensin converting enzyme inhibition, diabetic nephropathy, insulin-dependent diabetes mellitus, microalbuminuria",

author = "G. Boner and {Van Dyk}, {D. J.} and Tan, {M. H.} and J. Tan and A. Ekstrand and Koivisto, {V. A.} and Groop, {L. C.} and Groop, {P. H.} and A. Lucas and R. Romero and I. Salinas and A. Sanmarti and F. Escobar and F. Escobar-Jimenez and Campos-Pastor, {M. M.} and M. Mugoz and M. Gomez and R. Mangili and G. Pozza and D. Spotti and Hansen, {K. Wurgler} and Christiansen, {J. Sandahl} and F. Klein and Mogensen, {C. E.} and {Van Doorn}, {L. G.} and Spooren, {P. F M J} and Cruickshank, {J. K.} and J. Jervell and Paus, {P. N.} and Barnes, {D. J.} and A. Collins and Viberti, {G. C.} and G. Williams and Nelstrop, {G. A.} and L. Amorosa and Anolik, {J. R.} and Aronoff, {S. L.} and B. Eubank and M. Bailie and L. Pelletier and T. Blevins and Charles, {M. A.} and M. Perry and D. Clarke and D. Tomkey and D. Einhorn and D. Humphries and Garber, {A. J.} and B. Haag and E. Williams and W. Hoy and M. Watkins and D. Kahkonen and D. Kruger and C. Kilo and L. Laffel and E. Golden and P. Lodewick and Lovinsky and J. Mason and S. Johnson and J. McGill and L. Schmidt and P. Orlander and K. Sorenson and Philip Raskin and D. Hellenbrand and S. Rosenblatt and S. Schwartz and J. Aufieri and Sheehan, {J. P.} and M. Ulchaker and Skyler, {J. S.} and R. Agramonte and J. Starr and D. Gagliastre and T. Taylor and K. Dawn and Ward, {W. K.} and M. Rigdon",

year = "1996",

doi = "10.1007/BF00403306",

language = "English (US)",

volume = "39",

pages = "587--593",

journal = "Diabetologia",

issn = "0012-186X",

publisher = "Springer Verlag",

number = "5",

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TY - JOUR

T1 - Captopril reduces the risk of nephropathy in IDDM patients with microalbuminuria

AU - Boner, G.

AU - Van Dyk, D. J.

AU - Tan, M. H.

AU - Tan, J.

AU - Ekstrand, A.

AU - Koivisto, V. A.

AU - Groop, L. C.

AU - Groop, P. H.

AU - Lucas, A.

AU - Romero, R.

AU - Salinas, I.

AU - Sanmarti, A.

AU - Escobar, F.

AU - Escobar-Jimenez, F.

AU - Campos-Pastor, M. M.

AU - Mugoz, M.

AU - Gomez, M.

AU - Mangili, R.

AU - Pozza, G.

AU - Spotti, D.

AU - Hansen, K. Wurgler

AU - Christiansen, J. Sandahl

AU - Klein, F.

AU - Mogensen, C. E.

AU - Van Doorn, L. G.

AU - Spooren, P. F M J

AU - Cruickshank, J. K.

AU - Jervell, J.

AU - Paus, P. N.

AU - Barnes, D. J.

AU - Collins, A.

AU - Viberti, G. C.

AU - Williams, G.

AU - Nelstrop, G. A.

AU - Amorosa, L.

AU - Anolik, J. R.

AU - Aronoff, S. L.

AU - Eubank, B.

AU - Bailie, M.

AU - Pelletier, L.

AU - Blevins, T.

AU - Charles, M. A.

AU - Perry, M.

AU - Clarke, D.

AU - Tomkey, D.

AU - Einhorn, D.

AU - Humphries, D.

AU - Garber, A. J.

AU - Haag, B.

AU - Williams, E.

AU - Hoy, W.

AU - Watkins, M.

AU - Kahkonen, D.

AU - Kruger, D.

AU - Kilo, C.

AU - Laffel, L.

AU - Golden, E.

AU - Lodewick, P.

AU - Lovinsky,

AU - Mason, J.

AU - Johnson, S.

AU - McGill, J.

AU - Schmidt, L.

AU - Orlander, P.

AU - Sorenson, K.

AU - Raskin, Philip

AU - Hellenbrand, D.

AU - Rosenblatt, S.

AU - Schwartz, S.

AU - Aufieri, J.

AU - Sheehan, J. P.

AU - Ulchaker, M.

AU - Skyler, J. S.

AU - Agramonte, R.

AU - Starr, J.

AU - Gagliastre, D.

AU - Taylor, T.

AU - Dawn, K.

AU - Ward, W. K.

AU - Rigdon, M.

PY - 1996

Y1 - 1996

N2 - In insulin-dependent diabetes mellitus (IDDM), microalbuminuria predicts renal and cardiovascular disease. We report a combined analysis of 235 normotensive IDDM patients with microalbuminuria who participated in two 24-month double-blind, randomised, placebo-controlled trials to assess the effects of captopril 50 mg twice daily on the progression to overt clinical albuminuria. Of the 225 patients who were evaluable on an intent to treat basis, 25 of 114 placebo-treated patients (21.9%) and 8 of 111 captopril-treated patients (7.2%) progressed to persistent clinical albuminuria. The risk of progression over 24 months was significantly reduced by captopril (p = 0.004) with a risk reduction of 69.2% (95% confidence interval (CI): 31.7 to 86.1%). This degree of risk reduction remained at the same level (62.9% [16.1-83.6%], p = 0.017) after adjustment for differences in time-varying mean arterial blood pressure. Albumin excretion rate increased by an average of 14.2% [3.1-26.5%] per year in the placebo-treated group compared with a reduction of 9.6% [-18.6-0.4%] per year in the captopril-treated group (p = 0.002). The rate of fall of creatinine clearance tended to be faster in the placebo-treated group than in the captopril treated group (-6.4 [-10.2--2.5] vs -1.4 [-5.3-2.6] ml · min-1 · 1.73 m-2, p = 0.07). Baseline albumin excretion rate (p < 0.0001) and glycated haemoglobin (p = 0.03) were independent predictors of progression to clinical albuminuria and changes in mean arterial blood pressure (p = 0.02) and serum cholesterol level (p = 0.003) were significantly associated with percentage changes in albumin excretion rate. Captopril reduces the risk of progression to overt nephropathy in IDDM patients with microalbuminuria, an effect partly independent of its blood pressure-lowering effects.

AB - In insulin-dependent diabetes mellitus (IDDM), microalbuminuria predicts renal and cardiovascular disease. We report a combined analysis of 235 normotensive IDDM patients with microalbuminuria who participated in two 24-month double-blind, randomised, placebo-controlled trials to assess the effects of captopril 50 mg twice daily on the progression to overt clinical albuminuria. Of the 225 patients who were evaluable on an intent to treat basis, 25 of 114 placebo-treated patients (21.9%) and 8 of 111 captopril-treated patients (7.2%) progressed to persistent clinical albuminuria. The risk of progression over 24 months was significantly reduced by captopril (p = 0.004) with a risk reduction of 69.2% (95% confidence interval (CI): 31.7 to 86.1%). This degree of risk reduction remained at the same level (62.9% [16.1-83.6%], p = 0.017) after adjustment for differences in time-varying mean arterial blood pressure. Albumin excretion rate increased by an average of 14.2% [3.1-26.5%] per year in the placebo-treated group compared with a reduction of 9.6% [-18.6-0.4%] per year in the captopril-treated group (p = 0.002). The rate of fall of creatinine clearance tended to be faster in the placebo-treated group than in the captopril treated group (-6.4 [-10.2--2.5] vs -1.4 [-5.3-2.6] ml · min-1 · 1.73 m-2, p = 0.07). Baseline albumin excretion rate (p < 0.0001) and glycated haemoglobin (p = 0.03) were independent predictors of progression to clinical albuminuria and changes in mean arterial blood pressure (p = 0.02) and serum cholesterol level (p = 0.003) were significantly associated with percentage changes in albumin excretion rate. Captopril reduces the risk of progression to overt nephropathy in IDDM patients with microalbuminuria, an effect partly independent of its blood pressure-lowering effects.

KW - angiotensin converting enzyme inhibition

KW - diabetic nephropathy

KW - insulin-dependent diabetes mellitus

KW - microalbuminuria

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Captopril reduces the risk of nephropathy in IDDM patients with microalbuminuria

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