By Jill Stein
CHICAGO, IL -- June 25, 2007 -- Chronic telmisartan treatment may slow the progression of renal disease in patients with type 2 diabetes and diabetic nephropathy, irrespective of baseline glycaemic control, investigators reported here at the American Diabetes Association 67th Scientific Sessions (ADA).
George Bakris, MD, director, hypertension center, the University of Chicago Hospitals, Chicago, Illinois, United States, and associates presented a post-hoc subgroup analysis of the effect of metabolic control on treatment response in the AMADEO trial (A comparison of telMisartan versus losArtan in hypertensive type 2 DiabEtic patients with Overt nephropathy).
The AMADEO trial randomised 860 patients to 2 weeks of treatment with either telmisartan 40 mg or losartan 50 mg after a 4-week run-in period and then titrated patients to 50 weeks of treatment with telmisartan 80 mg or losartan 100 mg.
The data showed that the mean final urinary ratio of protein to creatinine (UPC) after 1 year of treatment was 0.71 in the telmisartan group and 0.80 in the losartan group (P =.028), for a reduction from baseline of 29% and 20% for the two groups, respectively.
"Poor glycaemic control is a major risk factor for the progression of diabetic nephropathy," Dr. Bakris pointed out in a presentation on June 23rd. "Angiotensin II receptor blockers (ARBs) have demonstrated efficacy in reducing the progression of renal disease in patients with type 2 diabetes, with losartan and irbesartan approved to slow progression of diabetic nephropathy."
Results of the subanalysis showed that there was no significant effect of baseline haemoglobin A1c (HbA1c) on the change in UPC in either telmisartan or losartan groups (P =.8335), or in the combined dataset (P =.4499) at the end of the trial.
Reduction from baseline UPC per HbA1c tertile (<=7.2%, >7.2% and <=8.3%, >8.3%) was 27%, 29%, and 30% for telmisartan, respectively, and 15%, 23%, and 23%, respectively for losartan.
Overall, the findings demonstrate that baseline HbA1c does not affect the change from baseline in UPC associated with ARB treatment, Dr. Bakris said.
[Presentation title: Influence of Glycaemic Control on Proteinuria in Patients With Type 2 Diabetes and Overt Nephropathy and Hypertension: Results of the AMADEO Trial. Abstract Number 601-P]
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