Effect of low-dose perindopril/indapamide on albuminuria in diabetes - Preterax in albuminuria regression: Premier

Carl Erik Mogensen, Giancarlo Viberti, Serge Halimi, Eberhard Ritz, Luis Ruilope, György Jermendy, Jiri Widimsky, Pinchas Sareli, Jan Taton, Juan Rull, Gürbüz Erdogan, Pieter W. De Leeuw, Arthur Ribeiro, Ramiro Sanchez, Rachid Mechmeche, John Nolan, Jana Sirotiakova, Ahmed Hamani, André Scheen, Bernhard HessAnton Luger, Stephen M. Thomas

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160 Citations (Scopus)

Abstract

Microalbuminuria in diabetes is a risk factor for early death and an indicator for aggressive blood pressure (BP) lowering. We compared a combination of 2 mg perindopril/0.625 mg indapamide with enalapril monotherapy on albumin excretion rate (AER) in patients with type 2 diabetes, albuminuria, and hypertension in a 12-month, randomized, double-blind, parallel-group international multicenter study. Four hundred eighty-one patients with type 2 diabetes and hypertension (systolic BP ≥140 mm Hg, <180 mm Hg, diastolic BP <110 mm Hg) were randomly assigned (age 59±9 years, 77% previously treated for hypertension). Results from 457 patients (intention-to-treat analysis) were available. After a 4-week placebo period, patients with albuminuria >20 and <500 μg/min were randomly assigned to a combination of 2 mg perindopril/0.625 mg indapamide or to 10 mg daily enalapril. After week 12, doses were adjusted on the basis of BP to a maximum of 8 mg perindopril/2.5 mg indapamide or 40 mg enalapril. The main outcome measures were overnight AER and supine BP. Both treatments reduced BP. Perindopril/indapamide treatment resulted in a statistically significant higher fall in both BP (-3.0 [95% CI -5.6, -0.4], P=0.012; systolic BP -1.5 [95% CI -3.0, -0.1] diastolic BP P=0.019) and AER -42% (95% CI -50%, -33%) versus -27% (95% CI -37%, -16%) with enalapril. The greater AER reduction remained significant after adjustment for mean BP. Adverse events were similar in the 2 groups. Thus, first-line treatment with low-dose combination perindopril/indapamide induces a greater decrease in albuminuria than enalapril, partially independent of BP reduction. A BP-independent effect of the combination may increase renal protection.

Original languageEnglish
Pages (from-to)1063-1071
Number of pages9
JournalHypertension
Volume41
Issue number5
DOIs
Publication statusPublished - May 1 2003

Keywords

  • Albuminuria
  • Angiotensin-converting enzyme
  • Diabetes mellitus
  • Hypertension, renal
  • Microalbuminuria

ASJC Scopus subject areas

  • Internal Medicine

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    Mogensen, C. E., Viberti, G., Halimi, S., Ritz, E., Ruilope, L., Jermendy, G., Widimsky, J., Sareli, P., Taton, J., Rull, J., Erdogan, G., De Leeuw, P. W., Ribeiro, A., Sanchez, R., Mechmeche, R., Nolan, J., Sirotiakova, J., Hamani, A., Scheen, A., ... Thomas, S. M. (2003). Effect of low-dose perindopril/indapamide on albuminuria in diabetes - Preterax in albuminuria regression: Premier. Hypertension, 41(5), 1063-1071. https://doi.org/10.1161/01.HYP.0000064943.51878.58