Effect of low-dose perindopril/indapamide on albuminuria in diabetes preterax in albuminuria regression: PREMIER

被引:148
作者
Mogensen, CE
Viberti, G
Halimi, S
Ritz, E
Ruilope, L
Jermendy, G
Widimsky, J
Sareli, P
Taton, J
Rull, J
Erdogan, G
De Leeuw, PW
Ribeiro, A
Sanchez, R
Mechmeche, R
Nolan, J
Sirotiakova, J
Hamani, A
Scheen, A
Hess, B
Luger, A
Thomas, SM
机构
[1] Aarhus Kommune Hosp, DK-8000 Aarhus, Denmark
[2] Kings Coll London, Guys Hosp, London WC2R 2LS, England
[3] CHU Grenoble, F-38043 Grenoble, France
[4] Fak Klin Med, Heidelberg, Germany
[5] Hosp 12 Octubre, E-28041 Madrid, Spain
[6] Bajcsy Zsilinsky Korhaz III Belosztaly, Budapest, Hungary
[7] IKEM, Prague, Czech Republic
[8] Univ Witwatersrand, Johannesburg, South Africa
[9] Katredra I Klin Chorob, Warsaw, Poland
[10] Inst Nacl Nutr, Mexico City, DF, Mexico
[11] Ankara Univ, Tip Fak, TR-06100 Ankara, Turkey
[12] Acad Ziekenhuis Maastricht, Maastricht, Netherlands
[13] Fundacao Oswaldo Cruz, Sao Paulo, Brazil
[14] Inst Cardiol & Cirurg Cardiovasc, Buenos Aires, DF, Argentina
[15] Hop La Rabta, Tunis Jabbart, Tunisia
[16] Dept Endocrinol, Dublin, Ireland
[17] Gen Hosp, Nitra, Slovakia
[18] Hop Mohammed V, Rabat, Morocco
[19] CHU Sart Tilman, B-4000 Liege, Belgium
[20] Inselspital Bern, Dept Endocrinol, CH-3010 Bern, Switzerland
关键词
albuminuria; microalbuminuria; hypertension; renal; diabetes mellitus; angiotensin-converting enzyme;
D O I
10.1161/01.HYP.0000064943.51878.58
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Microalbuminuria in diabetes is a risk factor for early death and an indicator for aggressive blood pressure (BP) lowering. We compared a combination of 2 mg perindopril/0.625 mg indapamide with enalapril monotherapy on albumin excretion rate (AER) in patients with type 2 diabetes, albuminuria, and hypertension in a 12-month, randomized, double-blind, parallel-group international multicenter study. Four hundred eighty-one patients with type 2 diabetes and hypertension (systolic BP greater than or equal to 140 mm Hg, <180 mm Hg, diastolic BP <110 mm Hg) were randomly assigned (age 59+/-9 years, 77% previously treated for hypertension). Results from 457 patients (intention-to-treat analysis) were available. After a 4-week placebo period, patients with albuminuria >20 and <500 mu g/min were randomly assigned to a combination of 2 mg perindopril/0.625 mg indapamide or to 10 mg daily enalapril. After week 12, doses were adjusted on the basis of BP to a maximum of 8 mg perindopril/2.5 mg indapamide or 40 mg enalapril. The main outcome measures were overnight AER and supine BP. Both treatments reduced BP. Perindopril/indapamide treatment resulted in a statistically significant higher fall in both BP (-3.0 [95% CI -5.6, -0.4], P=0.012; systolic BP -1.5 [ 95% CI -3.0, -0.1] diastolic BP P=0.019) and AER -42% (95% CI -50%, -33%) versus -27% (95% CI -37%, -16%) with enalapril. The greater AER reduction remained significant after adjustment for mean BP. Adverse events were similar in the 2 groups. Thus, first-line treatment with low-dose combination perindopril/indapamide induces a greater decrease in albuminuria than enalapril, partially independent of BP reduction. A BP-independent effect of the combination may increase renal protection.
引用
收藏
页码:1063 / 1071
页数:9
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