Renin-angiotensin-aldosterone system blockade and urinary albumin excretion in community-based patients with Type 2 diabetes: The Fremantle Diabetes Study

Diabet. Med. 28, 849–855 (2011) Aims To determine whether the reduction in urinary albumin excretion through renin–angiotensin–aldosterone system blockade found in intervention trials extends to community‐based patients with Type 2 diabetes. Methods We analysed data from 302 participants in the longitudinal observational Fremantle Diabetes Study who commenced angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker therapy during follow‐up and who had an annual assessment on either side of this therapeutic change. Results At baseline, the patients had a mean age of 63.8 years, a median diabetes duration of 4 years, a median HbA1c of 7.6% (60 mmol/mol) and a geometric mean (sd range) urinary albumin:creatinine ratio of 3.3 mg/mmol (0.8–13.1 mg/mmol). The percentages with normo‐, micro‐ and macroalbuminuria were 49.0, 38.4 and 12.6%, respectively. During 6.1 ± 1.7 years of follow‐up, initiation of renin–angiotensin–aldosterone system blockade was associated with a larger geometric mean (sd range) absolute albumin:creatinine ratio reduction in the patients with macroalbuminuria compared with those who had either normo‐ or microalbuminuria [−40.9 (−825.7 to 159.9) mg/mmol) vs. 1.7 (−1.6 to 20.0) mg/mmol and −0.5 (−23.0 to 39.5) mg/mmol, respectively; P