ANGIOTENSIN-CONVERTING ENZYME INHIBITORS SIGNIFICANTLY REDUCE PROGRESSION TO MACROALBUMINURIA AND INCREASE CHANCES OF REGRESSION IN NORMOTENSIVE PATIENTS WITH TYPE 1 DIABETES MELLITUS AND MICROALBUMINURIA.The ACE Inhibitors in Diabetic Nephropathy Trialist Group: Should all patients with type 1 diabetes mellitus type 1 diabetes mellitus Brittle DM, insulin-dependent DM, juvenile-onset DM Endocrinology A severe form of DM caused by ↓ endogenous insulin production by the pancreas, which comprises +– 10% of DM Clinical Extreme hyperglycemia, lability of glucose and microalbuminuria receive angiotensin-converting enzyme inhibitors Angiotensin-Converting Enzyme Inhibitors Definition Angiotensin-converting enzyme inhibitors (also called ACE inhibitors) are medicines that block the conversion of the chemical angiotensin I to a substance that increases salt and water retention in the ? Ann Intern Med 2001; 134:370-379 Studies that included at least 10 normotensive normotensive /nor·mo·ten·sive/ (-ten´siv) 1. characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. a person with normal blood pressure. patients with type 1 diabetes mellitus and microalbuminuria, had a placebo or nonintervention non·in·ter·ven·tion n. Failure or refusal to intervene, especially in the affairs of another nation. non group, and included at least 1 year of follow-up were identified from MEDLINE The online medical database of the U.S. National Library of Medicine (NLM) whose parent is the National Institutes of Health, Bethesda, MD. MEDLINE contains millions of articles from thousands of medical journals and publications. The consumer section of the site (http://medlineplus. and related bibliographies. Raw data were obtained for 698 patients from 12 trials. An analysis of treatment effect at 2 years was restricted to trials with at least 2 years of follow-up (646 patients from 10 trials). In those patients receiving angiotensin-converting enzyme (ACE) inhibitors, progression to macroalbuminuria was reduced (odds ratio [OR], 0.38; 95% CI, 0.25-0.57). The OR for regression to normoalbuminuria was 3.07 (CI, 2.154.44). At 2 years, albumin excretion rate was 50.5% lower (CI, 29.2%-65.5%) in treated patients versus those receiving a placebo (P [less than] .001). Estimated treatment effect varied by baseline albumin excretion rate (74.1% and 17.8% in patients with a rate of 200 [micro]g/min and 20 [micro]g/min, respectively [P = .04]). Adjustment for change in blood press ure prolonged the treatment difference in albumin excretion rate at 2 years to 45.1% (CI, 18.6%-63.1%; P[less than] .001). |
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