Endocrine Abstracts

Renin angiotensin system blockers are currently used in the treatment of diabetic nephropathy. Carvedilol, 3. generation beta-blockers, may provide additional benefits in diabetic patients. Its antiproteinuric activity is not investigated in patients with diabetic nephropathy. We aimed to compare short-term additive effects of losartan with cilazapril or carvedilol combination on blood pressure, proteinuria and renal functions in microalbuminuric patients with type 2 diabetes mellitus and hypertension.

Methods: Thirty patients with type 2 diabetes, stage 1 hypertension and albuminuria of 30–300 mg/day, were enrolled in the study. After the 2 week follow-up period, all patients were started on losartan 50 mg/day for 6 weeks. Then, they were randomized to three groups for 6 weeks: 1st group (n:10) on losartan 100 mg/day, 2nd group (n:10) on carvedilol 25 mg/day + losartan 50 mg/day and 3rd group (n:10) on cilazapril 5 mg/day + losartan 50 mg/day treatment.

Results: Characteristics of groups were similar. In all groups, systolic and diastolic blood pressures (BP) were significantly decreased. Greatest decrease in systolic (16.5±7.4 mmHg) and diastolic (10.5±2.8 mmHg) BPs were seen in group 3 and smallest decreases were seen in group 1 (systolic BP: 9±6.1 mmHg, diastolic BP: 3±4.8 mmHg). Microalbuminuria levels in all groups decreased significantly when compared to the period of 50 mg losartan alone (P<0.05). Renal functions of the groups did not change significantly. But creatinine clearances significantly increased in all groups after the randomization, although there was no significant difference between groups.

Conclusion: We observed that the combination of carvedilol in hypertensive type 2 diabetics patients with microalbuminuria safely controlled blood pressure more effectively without additional benefit in reducing microalbuminuria