MICROALBUMINURIA REDUCTION WITH EARLY PHARMACOTHERAPEUTIC INTERVENTION FOR BLOOD PRESSURE CONTROL IN CASES OF HYPERTENSIVE T2DM SUBJECTS

  • Dr. Sanjay Sud Consultant Medicine, Konnagar Municipal Hospital, Hooghly, India
Keywords: T2DM, Microalbuminuria, UACR, B.P., Hypertensive, HbA1c, pharmacotherapy

Abstract

Objective: A prospective randomized observational study to assess the importance of early intervention with pharmacotherapy to control B.P. in T2DM having microalbuminuria, and its reduction in comparison to a delayed initiation for the same.

Materials and methods: Patients with T2DM, HTN, and Microalbuminuria, on treatment for Diabetes but drug naïve for HTN were selected and divided into two groups. Group A was advised LSM for B.P. control but no pharmacotherapy. Group B gave the same advice plus Azilsartan 40 mg/day. UACR, B.P., and HbA1c were recorded on every visit. Second visit (3 months) Group A added on Azilsartan 40 mg/day to control the B.P. to target. Group B advised titration of Azilsartan dosage for the same. On the third visit (6 months) all the three parameters were recorded as before.

Results: (n=66) completed the study. (A=36 and B=30). The data analysis showed that at the end of 6 months ~33% of the patients in Group A could become non-microalbuminuric in comparison to ~67% of the patients in Group B. Reduction in microalbuminuria could be achieved in ~72% of patients from Group A, whereas ~87% of patients could achieve the same in Group B.

Conclusion: From the results of this study, it could be concluded that early initiation of pharmacotherapy in hypertensive T2DM patients to reduce B.P. helped to achieve a significantly beneficial effect on microalbuminuria reduction when compared to delayed initiation for the same even when the glycaemic goals and LSM were targeted with equal aggression in both the groups.

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References

1. Mogensen CE: Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 310: 356–360, 1984
2. Berrut G, Bouhanick B, Fabbri P, Guilloteau G, Bled F, Le Jeune JJ, Fressinaud P, Marre M: Microalbuminuria as a predictor of a drop in glomerular filtration rate in subjects with non-insulindependent diabetes mellitus and hypertension. Clin Nephrol 48:92–97, 1997
3. Keane WF, Brenner BM, de Zeeuw D, Grunfeld JP, McGill J, Mitch WE, RibeiroSud S., Med. Res. Chronicles., 6(3), 100-104 2019 AB, Shahinfar S, Simpson RL, napinn
SM, Toto R: The risk of developing the end-stage renal disease in patients with type 2 diabetes and nephropathy: the RENAAL study. Kidney Int 63:1499–1507, 2003
4. Pinto-Sietsma SJ, Janssen WM, Hillege HL, Navis G, De Zeeuw D, De Jong PE: Urinary albumin excretion is associated with renal functional abnormalities in a nondiabetic population. J Am Soc Nephrol 11:1882–1888, 2000
5. Anavekar NS, Gans DJ, Berl T, Rohde RD, Cooper W, Bhaumik A, Hunsicker LG, Rouleau JL, Lewis JB, Rosendorff C, Porush JG, Drury PL, Esmatjes E, Raz I, Vanhille P, Locatelli F, Goldhaber S, Lewis EJ, Pfeffer MA: Predictors of cardiovascular events in patients with type 2 diabetic nephropathy and hypertension: a case for albuminuria. Kidney Int Suppl S50–S55, 2004
6. Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, Remuzzi G, Snapinn SM, Zhang Z, Shahinfar S: Effects of losartan on renal and ardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 345:861–869, 2001
7. Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB, Ritz E, Atkins RC, Rohde R, Raz I: Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 345:851–860, 2001
8. Connell SJ, Hollis S, Tieszen KL, McMurray JR, Dornan TL: Gender and the clinical usefulness of the albumin: creatinine ratio. Diabet Med 11:32– 36, 1994
9. Palatini P, Mormino P, Mos L, Mazzer A, Dorigatti F, Zanata G, Longo D, Garbelotto R, De Toni R, Graniero G, Pessina AC: Microalbuminuria, renal function, and
development of sustained hypertension: a longitudinal study in the early stage of hypertension. J Hypertens 23:175–182, 2005
10. du Cailar G, Ribstein J, Mimran A: Dietary sodium and target organ damage in essential hypertension. Am J Hypertens 15:222–229, 2002
11. Mimran A, Ribstein J, DuCailar G, Halimi JM: Albuminuria in normals and essential hypertension. J Diabetes Complications 8:150–156, 1994
12. Redon J, Rovira E, Miralles A, Julie R, Pascual JM: Factors related to the occurrence of microalbuminuria during antihypertensive treatment in essential hypertension. Hypertension 39:794– 798, 2002
13. Verhave JC, Gansevoort RT, Hillege HL, Bakker SJ, De Zeeuw D, de Jong PE: An elevated urinary albumin excretion predicts de novo development of renal unction impairment in the general population. Kidney Int Suppl S18–S21, 2004
14. Hoy WE, Wang Z, VanBuynder P, Baker PR, Mathews JD: The natural history of renal disease in Australian Aborigines. Part 1. Changes in albuminuria and lomerular filtration rate over time. Kidney Int60:243– 248, 2001
15. Atkins RC, Briganti EM, Lewis JB, Hunsicker LG, Braden G, Champion de Crespigny PJ, DeFerrari G, Drury P, Locatelli F, Wiegmann TB, Lewis EJ: Proteinuria reduction and progression to renal failure in patients with type 2 diabetes mellitus and overt nephropathy. Am J Kidney Dis 45:281– 287, 2005
16. Epstein M: Adding spironolactone to conventional antihypertensives reduces albuminuria in patients with diabetic nephropathy. Nat Clin Pract Nephrol 2:310–311,
How to Cite
1.
Dr. Sanjay Sud. MICROALBUMINURIA REDUCTION WITH EARLY PHARMACOTHERAPEUTIC INTERVENTION FOR BLOOD PRESSURE CONTROL IN CASES OF HYPERTENSIVE T2DM SUBJECTS. Med. res. chronicles [Internet]. 2019Jun.30 [cited 2024Dec.26];6(3):100-4. Available from: https://medrech.com/index.php/medrech/article/view/376
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Original Research Article