P-562: Effect of manidipine and lisinopril on albuminuria and ventricular mass in diabetic hypertensive patients with microalbuminuria

The purpose of this study was to evaluate the effect of manidipine and lisinopril monotherapy on albumin excretion rate (AER) and left ventricular mass index (LVMI) in hypertensive patients with type 2 diabetic and microalbuminuria. We identified 106 mild to moderate hypertensive (DBP >90 ≤ 100 mmHg) patients with well controlled NIDDM and microalbuminuria, aged 46-68 ys. After a 4 week placebo period they were randomized to manidipine 10 mg od or to lisinopril 10 mg od; after 8 weeks the dose was doubled in the non responders (DBP ≥ 90 mmHg); after 16 weeks the non responders were excluded. The first year of the trial was completed by 75 patients. At the end of the placebo period and after 24 and 48 weeks of treatment BP, AER and LVMI were evaluated. The main results are as follow: (See Table) SBP DBP AER LVMI (mmHg) (mmHg) (mg/24h) (g/m2) Lisinopril baseline 151 ± 10 95 ± 4 78 ± 26 105 ± 15 (n=37) 24 weeks 137 ± 9** 85 ± 4** 44 ± 19** 102 ± 16 48 weeks 134 ± 9** 82 ± 5** 32 ± 17** 99 ± 13 Manidipine baseline 150 ± 11 95 ± 4 82 ± 28 107 ± 17 (n= 38) 24 weeks 138 ± 10** 85 ± 4** 75 ± 27 101 ± 14 48 weeks 132 ± 9** 81 ± 5** 69 ± 25 94 ± 12* *p< 0.05 **p< 0.01 vs baseline The 2 drugs had the same antihypertensive efficacy; however AER showed an earlier and greater reduction in the lisinopril than in manidipine group. On the opposite LVMI was significanly reduced only by manidipine; this effect could be due to the impaired calcium homeostasis of diabetic cardiomyopathy. On the hole these two complementary effects outline the rational of a ca antagonist-ace inhibitor combination in the treatment of diabetic hypertensive patients.