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Both ACE Inhibitors and ARBs Slow Renal Decline in Type 2 Diabetes

Both ACE Inhibitors and ARBs Slow Renal Decline in Type 2 Diabetes -- Posted by Gumbo on 10-31-04 05:15

Both ACE Inhibitors and ARBs Slow Renal Decline in Type 2 Diabetes

Peggy Peck
Aug. 31, 2004 (Munich, Germany) - In a head-to-head comparison, the
angiotensin-converting enzyme (ACE) inhibitor enalapril and the
angiotensin-receptor blocker (ARB) telmisartan were equally effective in
slowing kidney damage in people with type 2 diabetes, hypertension, and
nephropathy, according to results from the Diabetics Exposed to Telmisartan
and Enalapril (DETAILS) study reported here at the European Society of
Cardiology Congress 2004.

"The results show that telmisartan is a valid choice in selecting a
treatment," Anthony Barnett, MD, consulting physician and clinical director
of diabetes and endocrinology at Birmingham HeartLands Hospital and
professor of medicine at the University of Birmingham, U.K., said. Dr.
Barnett explained that the study represented the largest long-term look at
treatment of diabetic patients with kidney dysfunction.

Speaking at an ESC press conference, Dr. Barnett said the trial was designed
to "prove non inferiority of telmisartan to enalapril, and we were able to
show that."

The study randomized 250 patients to enalapril 10 mg for one month, with a
forced titration to 20 mg for 59 months or 40 mg of telmisartan for one
month and then 80 mg for the rest of the five-year period. "Doctors were
permitted to reduce the dosing if there were side effects, but that was rare
in the trial," Dr. Barnett said. Patients were excluded if they had
previously shown intolerability toward ACE inhibitors.

The primary outcome was change in glomerular filtration rate after five
years. In the telmisartan group, the average decline in the glomerular
filtration rate was 17.9 mL per minute, while in the enalapril group it was
14.9 mL per minute. The differences were not significant, Dr. Barnett said.

"There were no surprises with the outcomes in this study," said Lars Ryden,
MD, professor of cardiology at Karolinska Hospital in Stockholm, Sweden. "It
shows that doctors are correct in beginning treatment of these diabetic
patients with an ACE inhibitor." Dr. Ryden was not involved in the study.

In addition, a dramatic reduction in predicted mortality was seen with the
use of either drug. Dr. Barnett said the death rate over the five-year trial
was expected to be 35% to 50%, which was based on established five-year
mortality rates in people with newly diagnosed diabetic nephropathy. But
only six people in each group died - a 5% mortality rate. Moreover, none of
the patients in the study progressed to end-stage renal disease. About half
of the patients in the study had documented cardiovascular disease.

Asked if the findings illustrate a class effect for both ACE inhibitors and
ARBs, Dr. Barnett said "One assumes it is a class effect, but these are the
drugs that were used in the study. That is what the science shows."

Dr. Ryden agreed that the findings are likely to demonstrate a class effect
for the drugs, but he noted that that lipophilic ACE inhibitors such as
ramipril and enalapril, which was used in the study, are likely better
choices.

The study was funded by Boehringer-Ingelheim.

Re: Both ACE Inhibitors and ARBs Slow Renal Decline in Type 2 Diabetes -- Posted by Gillian Smith on 10-31-04 12:49

I was on Enalapril 5mg twice a day and was taken off it on the 31st August
this year. I have been coughing continually since the 23rd July. My
Cardiologist took me off the treatment because of the side effects I was
suffering. I am hoping the coughing will disappear eventually but I do have
my doubts. I have heart failure and type 2 Diabetes. Diet controlled. I
don't know if anyone is interested in this information
Gill
"Gumbo" wrote in message
news:cm2oh8$kl8$0@pita.alt.net...
> Both ACE Inhibitors and ARBs Slow Renal Decline in Type 2 Diabetes
>
>
> Peggy Peck
> Aug. 31, 2004 (Munich, Germany) - In a head-to-head comparison, the
> angiotensin-converting enzyme (ACE) inhibitor enalapril and the
> angiotensin-receptor blocker (ARB) telmisartan were equally effective in
> slowing kidney damage in people with type 2 diabetes, hypertension, and
> nephropathy, according to results from the Diabetics Exposed to
> Telmisartan
> and Enalapril (DETAILS) study reported here at the European Society of
> Cardiology Congress 2004.
>
>
> "The results show that telmisartan is a valid choice in selecting a
> treatment," Anthony Barnett, MD, consulting physician and clinical
> director
> of diabetes and endocrinology at Birmingham HeartLands Hospital and
> professor of medicine at the University of Birmingham, U.K., said. Dr.
> Barnett explained that the study represented the largest long-term look at
> treatment of diabetic patients with kidney dysfunction.
>
> Speaking at an ESC press conference, Dr. Barnett said the trial was
> designed
> to "prove non inferiority of telmisartan to enalapril, and we were able to
> show that."
>
> The study randomized 250 patients to enalapril 10 mg for one month, with a
> forced titration to 20 mg for 59 months or 40 mg of telmisartan for one
> month and then 80 mg for the rest of the five-year period. "Doctors were
> permitted to reduce the dosing if there were side effects, but that was
> rare
> in the trial," Dr. Barnett said. Patients were excluded if they had
> previously shown intolerability toward ACE inhibitors.
>
> The primary outcome was change in glomerular filtration rate after five
> years. In the telmisartan group, the average decline in the glomerular
> filtration rate was 17.9 mL per minute, while in the enalapril group it
> was
> 14.9 mL per minute. The differences were not significant, Dr. Barnett
> said.
>
> "There were no surprises with the outcomes in this study," said Lars
> Ryden,
> MD, professor of cardiology at Karolinska Hospital in Stockholm, Sweden.
> "It
> shows that doctors are correct in beginning treatment of these diabetic
> patients with an ACE inhibitor." Dr. Ryden was not involved in the study.
>
> In addition, a dramatic reduction in predicted mortality was seen with the
> use of either drug. Dr. Barnett said the death rate over the five-year
> trial
> was expected to be 35% to 50%, which was based on established five-year
> mortality rates in people with newly diagnosed diabetic nephropathy. But
> only six people in each group died - a 5% mortality rate. Moreover, none
> of
> the patients in the study progressed to end-stage renal disease. About
> half
> of the patients in the study had documented cardiovascular disease.
>
> Asked if the findings illustrate a class effect for both ACE inhibitors
> and
> ARBs, Dr. Barnett said "One assumes it is a class effect, but these are
> the
> drugs that were used in the study. That is what the science shows."
>
> Dr. Ryden agreed that the findings are likely to demonstrate a class
> effect
> for the drugs, but he noted that that lipophilic ACE inhibitors such as
> ramipril and enalapril, which was used in the study, are likely better
> choices.
>
> The study was funded by Boehringer-Ingelheim.
>
>

Re: Both ACE Inhibitors and ARBs Slow Renal Decline in Type 2 Diabetes -- Posted by Harvey R. Stone on 10-31-04 13:47

"Gillian Smith" <006e8869@blueyonder.co.uk> wrote in message
news:Xdchd.10717$T34.9083@fe2.news.blueyonder.co.uk...
>I was on Enalapril 5mg twice a day and was taken off it on the 31st August
>this year. I have been coughing continually since the 23rd July. My
>Cardiologist took me off the treatment because of the side effects I was
>suffering. I am hoping the coughing will disappear eventually but I do
>have my doubts. I have heart failure and type 2 Diabetes. Diet
>controlled. I don't know if anyone is interested in this information
> Gill

Thank you Gill,,, may you continue to improve.
harv

Re: Both ACE Inhibitors and ARBs Slow Renal Decline in Type 2 Diabetes -- Posted by Gumbo on 11-01-04 17:21

"Gillian Smith" <006e8869@blueyonder.co.uk> wrote in message
news:Xdchd.10717$T34.9083@fe2.news.blueyonder.co.uk...
> I was on Enalapril 5mg twice a day and was taken off it on the 31st August
> this year. I have been coughing continually since the 23rd July. My
> Cardiologist took me off the treatment because of the side effects I was
> suffering. I am hoping the coughing will disappear eventually but I do
have
> my doubts. I have heart failure and type 2 Diabetes. Diet controlled. I
> don't know if anyone is interested in this information
> Gill

No it's good to know any additional info always helps..

Feel Better..

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