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ABSTRACT
The aim of this study is to evaluate the effects of losartan on hypertension, glomerular hyperfiltration and urinary albumin excretion, and also assess the metabolic changes in comparison with ACEI. Thirty three type 2 diabetic hypertensive patients were enrolled in the study. Twenty patients were randomized to receive 50 mg/day losartan and 13 to 10 mg/day fosinopril. Patients were evaluated at the beginning and at the end of the 1st and 6th months. Blood pressure levels decreased significantly from 159. 0±21.3/99.0±11.3 mm/Hg to 146.0±12.9/89.0±13.9 mm/Hg and to 132.5±10.6/84.5±7.2 mm/Hg at the end of the first and sixth month (p=0.0013/p=0.0028) in the losartan group and from 156.5±21.4/97.0±9.2 mm/Hg to 144.5±31.1/85.5113.0 mm/Hg and to 136.0±8.8/84.5±4.4 mm/Hg (NS/p=0.0193) in the fosinopril group. The decrease in blood pressure levels was comparable between the two groups (26.5±22.5/14.5±10.7 mm/Hg and 20.5±23.9/12.51±1.4 mm/Hg respectively, NS). Glomerular filtration rate decreased from 186.5168.2 ml/min to 119.1±38.4 ml/min and 122.2±38.3 ml/min at the end of the 1st and 61h months (p<0.0001) in the losartan group. A similar trend was also observed in the fosinopril group (156.0±56.6 ml/min, 121.6±54.2 ml/min, and 113.1±36.5 ml/min respectively, p=0.033). The effect of each drug on GFR was similar (64.25±70.64 ml/min and 42.84±53.8 ml/min respectively, NS). Although there was no significant change in urinary albumin excretion rate at the end of the 6lt1 month of the study in the losartan group, fosinopril treatment significantly reduced urinary albumin excretion rate from 98.3±121.8 mg/day to 21.8±21.8 ml/day (p=0.0491). In the patient subgroup with microalbuminuria, urinary albumin excretion rate was decreased significantly from 136.6±92.4 ml/day to 38.0±38.6 mg/day (p=0.0027) at the end of the 1st month with losartan treatment, however an increase to 93.3±102.9 mg/day occurred at the end of the 6th month. Contrary to this result fosinopril treatment resulted in a progressive decrease from 171.01±27.6 mg/day to 94.5±89.8 mg/day and 18.01±3.6 mg/day (p=0.0031). Metabolic parameters did not deteriorate with either drug. As a result antihypertensive effects of the two drugs were found to be comparable, Although both drugs effectively reduced the increased glomerular filtration rate to normal, the early positive effect of losartan treatment on urinary albumin excretion was not observed at long term follow-up while fosinopril treatment resulted in a long term control. The results of this study confirm the efficacy and safety of losartan as an antihypertensive drug in diabetic patients, but the renal protective effects of ACEls stili seem to be significantly superior to angiotensin receptor antagonists.
The aim of this study is to evaluate the effects of losartan on hypertension, glomerular hyperfiltration and urinary albumin excretion, and also assess the metabolic changes in comparison with ACEI. Thirty three type 2 diabetic hypertensive patients were enrolled in the study. Twenty patients were randomized to receive 50 mg/day losartan and 13 to 10 mg/day fosinopril. Patients were evaluated at the beginning and at the end of the 1st and 6th months. Blood pressure levels decreased significantly from 159. 0±21.3/99.0±11.3 mm/Hg to 146.0±12.9/89.0±13.9 mm/Hg and to 132.5±10.6/84.5±7.2 mm/Hg at the end of the first and sixth month (p=0.0013/p=0.0028) in the losartan group and from 156.5±21.4/97.0±9.2 mm/Hg to 144.5±31.1/85.5113.0 mm/Hg and to 136.0±8.8/84.5±4.4 mm/Hg (NS/p=0.0193) in the fosinopril group. The decrease in blood pressure levels was comparable between the two groups (26.5±22.5/14.5±10.7 mm/Hg and 20.5±23.9/12.51±1.4 mm/Hg respectively, NS). Glomerular filtration rate decreased from 186.5168.2 ml/min to 119.1±38.4 ml/min and 122.2±38.3 ml/min at the end of the 1st and 61h months (p<0.0001) in the losartan group. A similar trend was also observed in the fosinopril group (156.0±56.6 ml/min, 121.6±54.2 ml/min, and 113.1±36.5 ml/min respectively, p=0.033). The effect of each drug on GFR was similar (64.25±70.64 ml/min and 42.84±53.8 ml/min respectively, NS). Although there was no significant change in urinary albumin excretion rate at the end of the 6lt1 month of the study in the losartan group, fosinopril treatment significantly reduced urinary albumin excretion rate from 98.3±121.8 mg/day to 21.8±21.8 ml/day (p=0.0491). In the patient subgroup with microalbuminuria, urinary albumin excretion rate was decreased significantly from 136.6±92.4 ml/day to 38.0±38.6 mg/day (p=0.0027) at the end of the 1st month with losartan treatment, however an increase to 93.3±102.9 mg/day occurred at the end of the 6th month. Contrary to this result fosinopril treatment resulted in a progressive decrease from 171.01±27.6 mg/day to 94.5±89.8 mg/day and 18.01±3.6 mg/day (p=0.0031). Metabolic parameters did not deteriorate with either drug. As a result antihypertensive effects of the two drugs were found to be comparable, Although both drugs effectively reduced the increased glomerular filtration rate to normal, the early positive effect of losartan treatment on urinary albumin excretion was not observed at long term follow-up while fosinopril treatment resulted in a long term control. The results of this study confirm the efficacy and safety of losartan as an antihypertensive drug in diabetic patients, but the renal protective effects of ACEls stili seem to be significantly superior to angiotensin receptor antagonists.