OR-54: Antiproteinuric efficacy of eplerenone, enalapril, and eplerenone/enalapril combination therapy in diabetic hypertensives with microalbuminuria
Hypertensive patients with diabetes have increased likelihood of proteinuria, a predictor of end-stage renal disease. This 24-week, double-blind study compared the renal and antihypertensive effects and the tolerability of eplerenone (EPL), a selective aldosterone blocker, enalapril (ENAL), an ACE i...
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| Veröffentlicht in: | American journal of hypertension 2002-04, Vol.15 (S3), p.24A-24A |
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| container_title | American journal of hypertension |
| container_volume | 15 |
| creator | Epstein, M. Buckalew, V. Martinez, F. Altamirano, J. Roniker, B. Kleiman, J. Krause, S. |
| description | Hypertensive patients with diabetes have increased likelihood of proteinuria, a predictor of end-stage renal disease. This 24-week, double-blind study compared the renal and antihypertensive effects and the tolerability of eplerenone (EPL), a selective aldosterone blocker, enalapril (ENAL), an ACE inhibitor, and EPL+ENAL combination therapy in hypertensive patients with diabetes and proteinuria. Diabetic type 2 patients with mild-to-moderate hypertension (DBP ≥95 mmHg and |
| doi_str_mv | 10.1016/S0895-7061(02)02333-6 |
| format | Article |
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This 24-week, double-blind study compared the renal and antihypertensive effects and the tolerability of eplerenone (EPL), a selective aldosterone blocker, enalapril (ENAL), an ACE inhibitor, and EPL+ENAL combination therapy in hypertensive patients with diabetes and proteinuria. Diabetic type 2 patients with mild-to-moderate hypertension (DBP ≥95 mmHg and <110mmHg; SBP <180 mmHg) and microalbuminuria (UACR ≥50 mg/g) were randomly assigned to receive EPL 200 mg QD, ENAL 40 mg QD, or EPL 200 mg/ENAL 10 mg (doses were reached by forced titration over 4 weeks). At Week 8 or later, if BP remained uncontrolled (DBP ≥90 mmHg), HCTZ 12.5 mg was added and further up-titrated to 25 mg if necessary. UACR, BP, and safety were assessed at Weeks 8 and 24. Geometric mean reductions in UACR and adjusted mean changes in SBP/DBP: Addition of HCTZ was required by 36/84 EPL patients, 43/81 ENAL patients, and 25/79 EPL+ENAL patients. Elevated K+ (≥6.0 mEq/L) was observed in 8 EPL, 2 ENAL, and 8 EPL+ENAL subjects. More patients were withdrawn for hyperkalemia in the EPL+ENAL group (14) than in the EPL (6) and ENAL (2) groups. Other AEs were similar among treatment groups. In conclusion, reduction of microalbuminuria, as assessed by UACR, was independent of the level of BP reduction, suggesting that selective aldosterone blockade with eplerenone has renoprotective effects in hypertensive patients with type 2 diabetes. Further investigation is warranted to determine whether lower eplerenone doses, or the combination of eplerenone with ACE inhibitors using different dose ratios, can reduce proteinuria with fewer K+ changes in diabetic hypertensives (see Figure).</description><identifier>ISSN: 0895-7061</identifier><identifier>EISSN: 1941-7225</identifier><identifier>DOI: 10.1016/S0895-7061(02)02333-6</identifier><identifier>CODEN: AJHYE6</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Antiproteinuric ; Diabetic Hypertensive ; Eplerenone</subject><ispartof>American journal of hypertension, 2002-04, Vol.15 (S3), p.24A-24A</ispartof><rights>Copyright Nature Publishing Group Apr 2002</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids></links><search><creatorcontrib>Epstein, M.</creatorcontrib><creatorcontrib>Buckalew, V.</creatorcontrib><creatorcontrib>Martinez, F.</creatorcontrib><creatorcontrib>Altamirano, J.</creatorcontrib><creatorcontrib>Roniker, B.</creatorcontrib><creatorcontrib>Kleiman, J.</creatorcontrib><creatorcontrib>Krause, S.</creatorcontrib><title>OR-54: Antiproteinuric efficacy of eplerenone, enalapril, and eplerenone/enalapril combination therapy in diabetic hypertensives with microalbuminuria</title><title>American journal of hypertension</title><addtitle>AJH</addtitle><description>Hypertensive patients with diabetes have increased likelihood of proteinuria, a predictor of end-stage renal disease. This 24-week, double-blind study compared the renal and antihypertensive effects and the tolerability of eplerenone (EPL), a selective aldosterone blocker, enalapril (ENAL), an ACE inhibitor, and EPL+ENAL combination therapy in hypertensive patients with diabetes and proteinuria. Diabetic type 2 patients with mild-to-moderate hypertension (DBP ≥95 mmHg and <110mmHg; SBP <180 mmHg) and microalbuminuria (UACR ≥50 mg/g) were randomly assigned to receive EPL 200 mg QD, ENAL 40 mg QD, or EPL 200 mg/ENAL 10 mg (doses were reached by forced titration over 4 weeks). At Week 8 or later, if BP remained uncontrolled (DBP ≥90 mmHg), HCTZ 12.5 mg was added and further up-titrated to 25 mg if necessary. UACR, BP, and safety were assessed at Weeks 8 and 24. Geometric mean reductions in UACR and adjusted mean changes in SBP/DBP: Addition of HCTZ was required by 36/84 EPL patients, 43/81 ENAL patients, and 25/79 EPL+ENAL patients. Elevated K+ (≥6.0 mEq/L) was observed in 8 EPL, 2 ENAL, and 8 EPL+ENAL subjects. More patients were withdrawn for hyperkalemia in the EPL+ENAL group (14) than in the EPL (6) and ENAL (2) groups. Other AEs were similar among treatment groups. In conclusion, reduction of microalbuminuria, as assessed by UACR, was independent of the level of BP reduction, suggesting that selective aldosterone blockade with eplerenone has renoprotective effects in hypertensive patients with type 2 diabetes. Further investigation is warranted to determine whether lower eplerenone doses, or the combination of eplerenone with ACE inhibitors using different dose ratios, can reduce proteinuria with fewer K+ changes in diabetic hypertensives (see Figure).</description><subject>Antiproteinuric</subject><subject>Diabetic Hypertensive</subject><subject>Eplerenone</subject><issn>0895-7061</issn><issn>1941-7225</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpNj8tKxDAYhYMoOF4eQQi4UbCaeyfuZPCGgjAOIm7K3_YPE-2kNc2o8yI-r0VFXJ3F-TiHj5A9zo454-bkno2tznJm-AETh0xIKTOzRkbcKp7lQuh1MvpDNslW3z8zxpQxfEQ-76aZVqf0LCTfxTahD8voK4rO-QqqFW0dxa7BiKENeEQxQANd9M0RhVD_q07-Glq1i9IHSL4NNM0xQreiPtDaQ4lp2J6vOowJQ-_fsKfvPs3pwlexhaZcLr7_YYdsOGh63P3NbTK7OJ9NrrLbu8vrydlt5o3Rmc2Z4hyYrXOnLIy1lUJJxayVValcLh0apmRdC6dKq8ZaWNTaKVGjAhAgt8n-z-yg_rrEPhXP7TIOIn3BmTA6V9bqgcp-KN8n_CgGxwXEVQHxpTC5zHVx9fhUGPswtTdjVkzkF7gketo</recordid><startdate>200204</startdate><enddate>200204</enddate><creator>Epstein, M.</creator><creator>Buckalew, V.</creator><creator>Martinez, F.</creator><creator>Altamirano, J.</creator><creator>Roniker, B.</creator><creator>Kleiman, J.</creator><creator>Krause, S.</creator><general>Oxford University Press</general><scope>BSCLL</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>200204</creationdate><title>OR-54: Antiproteinuric efficacy of eplerenone, enalapril, and eplerenone/enalapril combination therapy in diabetic hypertensives with microalbuminuria</title><author>Epstein, M. ; 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This 24-week, double-blind study compared the renal and antihypertensive effects and the tolerability of eplerenone (EPL), a selective aldosterone blocker, enalapril (ENAL), an ACE inhibitor, and EPL+ENAL combination therapy in hypertensive patients with diabetes and proteinuria. Diabetic type 2 patients with mild-to-moderate hypertension (DBP ≥95 mmHg and <110mmHg; SBP <180 mmHg) and microalbuminuria (UACR ≥50 mg/g) were randomly assigned to receive EPL 200 mg QD, ENAL 40 mg QD, or EPL 200 mg/ENAL 10 mg (doses were reached by forced titration over 4 weeks). At Week 8 or later, if BP remained uncontrolled (DBP ≥90 mmHg), HCTZ 12.5 mg was added and further up-titrated to 25 mg if necessary. UACR, BP, and safety were assessed at Weeks 8 and 24. Geometric mean reductions in UACR and adjusted mean changes in SBP/DBP: Addition of HCTZ was required by 36/84 EPL patients, 43/81 ENAL patients, and 25/79 EPL+ENAL patients. Elevated K+ (≥6.0 mEq/L) was observed in 8 EPL, 2 ENAL, and 8 EPL+ENAL subjects. More patients were withdrawn for hyperkalemia in the EPL+ENAL group (14) than in the EPL (6) and ENAL (2) groups. Other AEs were similar among treatment groups. In conclusion, reduction of microalbuminuria, as assessed by UACR, was independent of the level of BP reduction, suggesting that selective aldosterone blockade with eplerenone has renoprotective effects in hypertensive patients with type 2 diabetes. Further investigation is warranted to determine whether lower eplerenone doses, or the combination of eplerenone with ACE inhibitors using different dose ratios, can reduce proteinuria with fewer K+ changes in diabetic hypertensives (see Figure).</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><doi>10.1016/S0895-7061(02)02333-6</doi></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Antiproteinuric Diabetic Hypertensive Eplerenone |
| title | OR-54: Antiproteinuric efficacy of eplerenone, enalapril, and eplerenone/enalapril combination therapy in diabetic hypertensives with microalbuminuria |
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