The Pharmaceutical Journal
Vol 270 No 7245 p538
19 April 2003

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Annals of Internal Medicine abstract (more)

No leading drug for type 2 nephropathy

Patients with type 2 diabetic nephropathy have similar overall cardiovascular outcomes whether they are treated with irbesartan (Aprovel), amlodipine (Istin) or placebo, a new analysis suggests.

Investigators from the irbesartan diabetic nephropathy trial (IDNT), who previously showed that this group of high-risk patients have better renal protection when treated with irbesartan rather than amlodipine, monitored cardiovascular outcomes in 1,715 patients taking part in the trial. The secondary analyses showed no differences in overall cardiovascular outcomes between patients given irbesartan or amlodipine in addition to conventional antihypertensive therapy. However, fewer patients given irbesartan had heart failure and fewer patients given amlodipine had myocardial infarctions. "Our trial thus suggests that angiotensin-receptor blockers and angiotensin-converting enzyme inhibitors may have differential effects in these patients," say the researchers.

The researchers comment that cumulative data generated from various trials provide "no clear and consistent pattern" for the superiority of one class of agents over another. "This neutral effect may be a consequence of the fact that composite cardiovascular events frequently involve several components whose pathophysiology is not uniform," they conclude (Annals of Internal Medicine 2003;138:542).