Article (Scientific journals)
Effect of low-dose perindopril/indapamide on albuminuria in diabetes: preterax in albuminuria regression: PREMIER.
Mogensen, Carl Erik; Viberti, Giancarlo; Halimi, Serge et al.
2003In Hypertension, 41 (5), p. 1063-71
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Keywords :
angiotensin-converting enzyme; diabetes mellitus; hypertension, renal; microalbuminuria; albuminuria; Adult; Aged; Albuminuria/drug therapy/etiology/urine; Antihypertensive Agents/adverse effects/therapeutic use; Blood Pressure/drug effects; Cough/chemically induced; Diabetes Mellitus, Type 2/complications/physiopathology; Dizziness/chemically induced; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Enalapril/adverse effects/therapeutic use; Female; Follow-Up Studies; Humans; Indapamide/adverse effects/therapeutic use; Male; Middle Aged; Perindopril/adverse effects/therapeutic use; Treatment Outcome
Abstract :
[en] 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 > or =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 microg/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.
Disciplines :
Pharmacy, pharmacology & toxicology
Cardiovascular & respiratory systems
Author, co-author :
Mogensen, Carl Erik
Viberti, Giancarlo
Halimi, Serge
Ritz, Eberhard
Ruilope, Luis
Jermendy, Gyorgy
Widimsky, Jiri
Sareli, Pinchas
Taton, Jan
Rull, Juan
Erdogan, Gurbuz
De Leeuw, Pieter W
Ribeiro, Arthur
Sanchez, Ramiro
Mechmeche, Rachid
Nolan, John
Sirotiakova, Jana
Hamani, Ahmed
Scheen, André  ;  Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Hess, Bernhard
Luger, Anton
Thomas, Stephen M
More authors (12 more) Less
Language :
English
Title :
Effect of low-dose perindopril/indapamide on albuminuria in diabetes: preterax in albuminuria regression: PREMIER.
Publication date :
2003
Journal title :
Hypertension
ISSN :
0194-911X
eISSN :
1524-4563
Publisher :
American Heart Association, Dallas, United States - Texas
Volume :
41
Issue :
5
Pages :
1063-71
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 05 December 2008

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