Aliskiren in combination with losartan reduces albuminuria independent of baseline blood pressure in patients with type 2 diabetes and nephropathy.

Persson F, Lewis JB, Lewis EJ, Rossing P, Hollenberg NK, Parving HH
Clin J Am Soc Nephrol. 2011 6 (5): 1025-31

PMID: 21350110 · PMCID: PMC3087767 · DOI:10.2215/CJN.07590810

BACKGROUND AND OBJECTIVES - Elevated BP contributes to development and progression of proteinuria and decline in renal function in patients with type 2 diabetes. Our post hoc analysis assessed the baseline BP influence on the antiproteinuric effect in the Aliskiren in the Evaluation of Proteinuria in Diabetes (AVOID) study.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS - In the AVOID study, 599 hypertensive type 2 diabetic patients with nephropathy received 6 months of aliskiren (150 mg force titrated to 300 mg daily after 3 months) or placebo added to losartan (100 mg) daily and optimal antihypertensive therapy. Changes in early morning urinary albumin:creatinine ratio and eGFR at week 24 were assessed by subgroups of baseline BP: Group A (prespecified target), <130/80 mmHg (n=159); Group B, <140/90 mmHg but ≥130/80 mmHg (n=189); and Group C (insufficient BP control), ≥140/90 mmHg (n=251).

RESULTS - Mean baseline BP (mmHg) levels for Groups A, B, and C were 120/71, 133/78, and 145/81, respectively. BP during the trial was nearly identical to baseline levels in all groups. The antiproteinuric effects of aliskiren were consistent across subgroups of baseline BP (19 to 22% reduction versus placebo). In Group C, the decline in eGFR was significantly lower with aliskiren than with placebo (P=0.013).

CONCLUSIONS - Aliskiren (300 mg) added to losartan (100 mg) plus optimal antihypertensive therapy provides antiproteinuric effects independent of BP in patients with type 2 diabetes and nephropathy. Renal function was better preserved with aliskiren in patients with insufficient BP control.

Copyright © 2011 by the American Society of Nephrology

MeSH Terms (17)

Aged Albuminuria Amides Antihypertensive Agents Blood Pressure Diabetes Mellitus, Type 2 Diabetic Nephropathies Drug Therapy, Combination Female Fumarates Humans Hypertension, Renal Losartan Male Middle Aged Placebos Treatment Outcome

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