K006: Candesartan decreases proteinuria and improves creatinine clearance in hypertensive diabetic patients

Optimal antihypertensive therapy for diabetic patients should include the diminution of proteinuria, a poor prognostic indicator of nephropathy. ACE inhibitors had been shown to decrease proteinuria, but there is no study on the effect of angiotensin II receptor inhibitors (ARB) on proteinuria in diabetic patients. Therefore we studied the effects of candesartan, a long acting ARB on proteinuria and creatinine clearance (CrCl) in hypertensive diabetic patients. Candesartan 8–16 mg/d were given to 7 hypertensive diabetics (4 women, 3 men, 50–74 y) with proteinuria. Their DM were managed with glyburide (glycohemoglobin 7.2 ± 1.1%), and their blood pressure responded to candesartan monotherapy. Basal 24 h urine studies were done. Blood pressure was monitored weekly, and 24 h urine protein and CrCl were measured every 3 months. Blood pressure normalized within 3 weeks, proteinuria decreased and CrCl improved by 3 months. (See Table) Basal 3 mo 6 mo 9 mo PU* 1.24 ± 0.55 1.03 ± 0.39# 0.95 ± 0.18 0.82 ± 0.20 g/d CrCl 40 ± 15 47 ± 10# 51 ± 16 58 ± 11/min *Proteinuria #p < 0.01 from basal. Thus, candesartan decreases proteinuria and improves renal function. Candesartan may be an alternative drug for hypertensive diabetics with nephropathy who cannot take ACE inhibitors.