P-365: Long-term safety of high dose ARB therapy: Effects on renal function

Reducing urinary protein excretion in diabetic patients is an important therapeutic target to prevent the progression of renal and cardiovascular disease. Drugs (e.g. ACE inhibitors and/or angiotensin receptor blockers (ARB)) which block the actions of the renin-angiotensin system are recommended as they reduce blood pressure (BP) and proteinuria. Recently higher doses of ARB, up to 3 times the maximally approved dose, have been demonstrated to reduce urinary protein excretion. Despite the effectiveness of this therapeutic approach no long term safety analysis of patients using high dose ARB therapy has been conducted. We studied 34 patients (age=62±15 yrs; 94±21 kg; 31 males) in a hypertension and renal disease clinic for over 31±16 months who had their existing ARB (e.g. valsartan, candesartan, irbesartan, olmesartan) dose increased 1.5-5 times greater than the maximum approved dose for that particular ARB. ARB doses increased over time and were 3.2±1.4 times greater than the dose at study start. BP was well-controlled throughout the study as systolic BP was similar between the beginning (132 mmHg) and the end (130 mmHg) of the study. Diastolic BP decreased from baseline throughout the study and was lower (p