Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes - PubMed (original) (raw)
Clinical Trial
. 2001 Sep 20;345(12):851-60.
doi: 10.1056/NEJMoa011303.
Affiliations
- PMID: 11565517
- DOI: 10.1056/NEJMoa011303
Free article
Clinical Trial
Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes
E J Lewis et al. N Engl J Med. 2001.
Free article
Abstract
Background: It is unknown whether either the angiotensin-II-receptor blocker irbesartan or the calcium-channel blocker amlodipine slows the progression of nephropathy in patients with type 2 diabetes independently of its capacity to lower the systemic blood pressure.
Methods: We randomly assigned 1715 hypertensive patients with nephropathy due to type 2 diabetes to treatment with irbesartan (300 mg daily), amlodipine (10 mg daily), or placebo. The target blood pressure was 135/85 mm Hg or less in all groups. We compared the groups with regard to the time to the primary composite end point of a doubling of the base-line serum creatinine concentration, the development of end-stage renal disease, or death from any cause. We also compared them with regard to the time to a secondary, cardiovascular composite end point.
Results: The mean duration of follow-up was 2.6 years. Treatment with irbesartan was associated with a risk of the primary composite end point that was 20 percent lower than that in the placebo group (P=0.02) and 23 percent lower than that in the amlodipine group (P=0.006). The risk of a doubling of the serum creatinine concentration was 33 percent lower in the irbesartan group than in the placebo group (P=0.003) and 37 percent lower in the irbesartan group than in the amlodipine group (P<0.001). Treatment with irbesartan was associated with a relative risk of end-stage renal disease that was 23 percent lower than that in both other groups (P=0.07 for both comparisons). These differences were not explained by differences in the blood pressures that were achieved. The serum creatinine concentration increased 24 percent more slowly in the irbesartan group than in the placebo group (P=0.008) and 21 percent more slowly than in the amlodipine group (P=0.02). There were no significant differences in the rates of death from any cause or in the cardiovascular composite end point.
Conclusions: The angiotensin-II-receptor blocker irbesartan is effective in protecting against the progression of nephropathy due to type 2 diabetes. This protection is independent of the reduction in blood pressure it causes.
Comment in
- Prevention of end-stage renal disease due to type 2 diabetes.
Hostetter TH. Hostetter TH. N Engl J Med. 2001 Sep 20;345(12):910-2. doi: 10.1056/NEJM200109203451209. N Engl J Med. 2001. PMID: 11565525 No abstract available. - Angiotensin-receptor blockers, type 2 diabetes, and renoprotection.
Blankfield RP. Blankfield RP. N Engl J Med. 2002 Feb 28;346(9):705-7. doi: 10.1056/NEJM200202283460912. N Engl J Med. 2002. PMID: 11870250 No abstract available. - Angiotensin-receptor blockers, type 2 diabetes, and renoprotection.
Walser M. Walser M. N Engl J Med. 2002 Feb 28;346(9):705-7. N Engl J Med. 2002. PMID: 11873778 No abstract available. - Angiotensin-receptor blockers, type 2 diabetes, and renoprotection.
Ceriello A, Motz E. Ceriello A, et al. N Engl J Med. 2002 Feb 28;346(9):705-7. N Engl J Med. 2002. PMID: 11873779 No abstract available. - Irbesartan reduced progression of nephropathy caused by type 2 diabetes independent of the effect on blood pressure.
Rabbat CG. Rabbat CG. ACP J Club. 2002 May-Jun;136(3):82-4. ACP J Club. 2002. PMID: 11985424 No abstract available.
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