The Pharmaceutical Journal
Vol 273 No 7315 p305
4 September 2004

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Kidney protection in diabetes comparable for angiotensin receptor blocker and ACE inhibitor

Telmisartan, the angiotensin receptor blocker (ARB), is comparable to the angiotensin converting enzyme (ACE) inhibitor enalapril in protecting against deterioration in kidney function in patients with type 2 diabetes, according to results from the first long-term study to compare the two drug classes.

The study randomised 250 patients with type 2 diabetes, hypertension and early nephropathy to telmisartan (80mg once daily) or enalapril (20mg daily) for five years. All had previously been on an ACE inhibitor for at least three months.

Results, reported this week at the European Society of Cardiology in Munich, showed similar protection against further loss of kidney function. Over the five years, the mean fall in glomerular filtration rate (GFR) was 17.9ml/min/1.73m2 with telmisartan and 14.8ml/min/1.73m2 with enalapril. Tony Barnett, professor of medicine, University of Birmingham, pointed out that diabetes patients with proteinuria not treated with renoprotective agents show a GFR reduction of about 50–60ml/min/1.73m2 over five years.

The mortality rate in the study was 5 per cent over five years, which was half that expected. “The results showed comparable efficacy of telmisartan and enalapril, making the ARB a valid choice for first-line treatment of hypertensive type 2 diabetes patients with early nephropathy,” Professor Barnett concluded.