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Incidence of Cardiac Events Similar Between Amlodipine And Irbesartan in Diabetic Patients with Overt Nephropathy: Presented at ASN

By Maggie Schwarz
Special to DG News

PHILADELPHIA, PA -- November 3, 2002 -- In diabetic patients with overt nephropathy, those taking amlodipine have fewer strokes and myocardial infarctions, and those taking irbesartan have a lower rate of congestive heart failure, but the two have comparable composite cardiovascular event rates.

Dr. Tomas Berl, speaking for the Collaborative Study Group at the University of Colorado, in Denver, Colorado, and Rush Medical Center, in Chicago, Illinois, United States, presented results of a prospective, double-blind, placebo-controlled comparison of cardiovascular events in diabetic patients here November 1 at the 35^th Annual Meeting of the American Society of Nephrology.

Mean follow-up time was 2.6 years, and composite cardiovascular outcome was time to cardiovascular death, nonfatal myocardial infarction, congestive heart failure, stroke, coronary and peripheral revascularisation and amputations. The researchers enrolled 1,715 hypertensive adults with serum creatinine 1.0 to 3.0 mg percent in women, 1.2 mg percent and 3.0 mg percent in men, and urinary protein excretion at least 900 mg/24 hours.

Placebo, irbesartan and amlodipine did not differ in the composite of cardiovascular events, nor was there any significant difference noted in time to cardiovascular death, amputations or carotid and peripheral artery revascularisation. A trend was noted toward a decrease in the incidence of stroke among patients taking amlodipine versus those taking placebo (relative risk [RR], 0.65).

Patients taking amlodipine had a significantly lower rate of nonfatal myocardial infarction when compared with placebo (RR, 0.58, p=0.02). Patients on irbesartan had a significantly lower incidence of congestive heart failure when compared to placebo (RR, .72, p=0.048) or amlodipine (RR, 0.65, p=0.004).

Dr. Berl concluded that the incidence of composite cardiovascular events does not differ for the calcium channel blocker versus the angiotensin receptor blocker in diabetic patients with overt nephropathy.

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