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Losartan, Enalapril May Not Slow Diabetic Nephropathy

Last Updated: July 01, 2009.

Drugs that blockade the renin-angiotensin system may not reduce progression of nephropathy in patients with type 1 diabetes, but they do slow the progression of retinopathy, according to a study published in the July 2 issue of the New England Journal of Medicine.

WEDNESDAY, July 1 (HealthDay News) -- Drugs that blockade the renin-angiotensin system may not reduce progression of nephropathy in patients with type 1 diabetes, but they do slow the progression of retinopathy, according to a study published in the July 2 issue of the New England Journal of Medicine.

Michael Mauer, M.D., of the University of Minnesota in Minneapolis, and colleagues conducted a study of 285 type 1 diabetes patients, with normal blood pressure and albumin levels, who were randomized to received either 100 mg/day losartan, 20 mg/day enalapril, or placebo. The cohort was followed for five years.

All three groups had similar changes in mesangial fractional volume per glomerulus over five years, and the placebo group had a 6 percent incidence of microalbuminuria, compared to 17 percent for the losartan group and 4 percent for the enalapril group, the investigators note. The enalapril and losartan groups had a reduction of two steps or more for retinopathy progression of 65 and 70 percent, respectively, versus the placebo group, the researchers discovered.

"Given the current status of our ability to predict the risk of nephropathy, blockade of the renin-angiotensin system for the primary prevention of diabetic nephropathy in patients with type 1 diabetes is not supported by the present evidence," the authors conclude.

The study was partially funded by Merck in the United States and Merck Frosst in Canada. Authors of the study and accompanying editorial reported financial relationships with Merck.

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