0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
ARTICLE |

Comparative Effects of Different Antihypertensive Treatments on Progression of Diabetic Renal Disease

Richard Slataper, MD; Nancy Vicknair, AB; Rebecca Sadler, LRD; George L. Bakris, MD
Arch Intern Med. 1993;153(8):973-980. doi:10.1001/archinte.1993.00410080037006.
Text Size: A A A
Published online

Background:  Given the same level of arterial pressure control, studies in diabetic animal models have demonstrated certain classes of antihypertensive medication to confer better overall preservation of renal histologic features and function as well as reduced albuminuria when compared with other agents. The present study was designed to assess whether any differences exist among antihypertensive agents with regard to progression of diabetic renal disease and albuminuria in human subjects.

Methods:  The study was a randomized, prospective, parallel group design that evaluated the effects of a converting enzyme inhibitor (lisinopril; group 1), a calcium antagonist (diltiazem hydrochloride; group 2), and a combination of a loop diuretic and a β-blocker (furosemide and atenolol; group 3) in 30 subjects. All subjects received a low-salt, low-protein diet. Metabolic (blood glucose, cholesterol profiles, and urine urea nitrogen and sodium levels) as well as renal hemodynamic (renal blood flow and glomerular filtration rate) profiles and arterial pressure measurements were performed at various intervals during an 18-month period.

Results:  Both groups 1 and 2 had significantly slower rates of decline in glomerular filtration rate compared with group 3. No significant differences were observed in renal hemodynamics between groups 1 and 2 at 18 months. Group 3 had the worst metabolic, lipid, and side-effect profile of any group. Reductions in albuminuria were not different between groups 1 and 2, but both were significantly reduced compared with group 3.

Conclusions:  Given a similar level of arterial pressure control, both lisinopril and diltiazem slow progression of diabetic renal disease and reduce albuminuria to a greater extent than does the combination of a loop diuretic and β-adrenoreceptor antagonist. These drugs were also better tolerated and produced no adverse metabolic effects.(Arch Intern Med. 1993;153:973-980)

Topics

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 134

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();