Article (Scientific journals)
Equivalence of indapamide SR and enalapril on microalbuminuria reduction in hypertensive patients with type 2 diabetes: The NESTOR* study
Marre, Michel; Garcia Puig, Juan; Kokot, Franciszek et al.
2004In Journal of Hypertension, 22 (8), p. 1613-1622
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Keywords :
hypertension; type 2 diabetes; microalbuminuria; indapamide sustained release; enalapril; randomized trial; diuretics; angiotensin-converting enzyme inhibitors
Abstract :
[en] Objectives To test whether microalbuminuria in patients with type 2 diabetes and hypertension is primarily dependent on the severity of hypertension, and to compare the effectiveness of two anti hypertensive drugs with opposite effects on the renin-angiotensin system [the diuretic, indapamide sustained release (SR), and an angiotensin-converting enzyme inhibitor, enalapril] in reducing microalbuminuria. Design A multinational, multicentre, controlled, double-blind, double-dummy, randomized, two-parallel-groups study over 1 year. Methods After a 4-week placebo run-in period, 570 patients (ages 60.0 +/- 9.9 years, 64% men) with type 2 diabetes, essential hypertension [systolic blood pressure (SBP) 140-180 mmHg, and diastolic blood pressure (DBP) < 110 mmHg], and persistent microalbuminuria (20-200 mu g/min) were allocated randomly to groups to receive indapamide SR 1.5 mg (n = 284) or enalapril 10 mg (n = 286) once a day. Amlodipine, atenolol, or both were added, if necessary, to achieve the target blood pressure of 140/85 mmHg. Results There was a significant reduction in the urinary albumin: creatinine ratio. Mean reductions were 35% [95% confidence interval (Cl) 24 to 43] and 39% (95% Cl 30 to 47%) in the indapamide SR and enalapril groups, respectively. Equivalence was demonstrated between the two groups [1.08 (95% Cl 0.89 to 1.31%); P = 0.01]. The reductions in mean arterial pressure (MAP) were 16.6 +/- 9.0 mmHg for the indapamide SR group and 15.0 +/- 9.1 mmHg for the enalapril group (NS); the reduction in SBP was significantly greater (P = 0.0245) with indapamide SR. More than 50% of patients in each group required additional antihypertensive therapy, with no differences between groups. Both treatments were well tolerated. Conclusions lndapamide-SR-based therapy is equivalent to enalapril-based therapy in reducing microalbuminuria with effective blood pressure reduction in patients with hypertension and type 2 diabetes.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Marre, Michel
Garcia Puig, Juan
Kokot, Franciszek
Fernandez, Margarita
Jermendy, György
Opie, Lionel
Moyseev, Valentin
Scheen, André  ;  Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Ionescu-Tirgoviste, Constantin
Saldanha, M. Héléna
Halabe, Aaron
Williams, Bryan
Mion, Decio
Ruiz, Maximino
Hermansen, Kjeld
Tuomilehto, Jaakko
Finizola, Bartolomé
Gallois, Yves
Amouyel, Philippe
Ollivier, Jean-Pierre
Asmar, Roland
More authors (11 more) Less
Language :
English
Title :
Equivalence of indapamide SR and enalapril on microalbuminuria reduction in hypertensive patients with type 2 diabetes: The NESTOR* study
Publication date :
August 2004
Journal title :
Journal of Hypertension
ISSN :
0263-6352
eISSN :
1473-5598
Publisher :
Lippincott Williams & Wilkins, Philadelphia, United States - Pennsylvania
Volume :
22
Issue :
8
Pages :
1613-1622
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 16 March 2009

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