Trial reportBMJ (Clinical research ed.)1993
Comparison of reduction in microalbuminuria by enalapril and hydrochlorothiazide in normotensive patients with insulin dependent diabetes.
Trial report in BMJ (Clinical research ed.), 1993. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 83 citations in OpenAlex.
- Trial
- Captopril reduces the risk of nephropathy in IDDM patients with microalbuminuria. The Microalbuminuria Captopril Study Group.Diabetologia · 1996Trial
- Lisinopril reduces postexercise albuminuria more effectively than atenolol in primary hypertension.European journal of clinical pharmacology · 1996Trial
- Microalbuminuria risks and glomerular filtration in children with sickle cell anaemia in Nigeria.Italian journal of pediatrics · 2019Article
- Redefining diuretics use in hypertension: why select a thiazide-like diuretic?Journal of hypertension · 2019Article
- Long-term prevention of diabetic nephropathy: an audit.Diabetologia · 2008Article
- Treatment of hypertension in diabetic patients with nephropathy.Current diabetes reports · 2001Review
- Review
- Review
- Contribution of genetic polymorphism in the renin-angiotensin system to the development of renal complications in insulin-dependent diabetes: Genetique de la Nephropathie Diabetique (GENEDIAB) study group.The Journal of clinical investigation · 1997Article
- Diabetic vascular injury and ACE. Potential for pharmacological prevention of complications of later life.Drugs & aging · 1996Review
- Renoprotective role of ACE inhibitors in diabetic nephropathy.British heart journal · 1994Review
- New concepts in diabetes mellitus. II: Complications.Postgraduate medical journal · 1994Review
- Is screening and intervention for microalbuminuria worthwhile in patients with insulin dependent diabetes?BMJ (Clinical research ed.) · 1993Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo compare the effects of sodium depletion and of angiotensin I converting enzyme inhibition on microalbuminuria in insulin dependent diabetes.
designRandomised, double blind, double dummy parallel study of normotensive diabetic patients with persistent microalbuminuria (30-300 mg/24 h) treated with enalapril or hydrochlorothiazide for one year after a three month, single blind placebo period.
settingDiabetic clinic in a tertiary referral centre. PATIENTS: 10 diabetic patients with low microalbuminuria (30-99 mg/24 h) and 11 with high microalbuminuria (100-300 mg/24 h).
interventions11 subjects (six with low microalbuminuria, five with high microalbuminuria) were given enalapril 20 mg plus placebo hydrochlorothiazide once daily and 10 (four with low microalbuminuria, six with high microalbuminuria) hydrochlorothiazide 25 mg plus placebo enalapril once daily.
main outcome measuresMonthly assessment of urinary albumin excretion and mean arterial pressure; plasma active renin and aldosterone concentrations and renal function studies at 0, 6, and 12 months.
resultsMedian urinary albumin excretion decreased from 59 (range 37-260) to 38 (14-146) mg/24 h with enalapril and from 111 (33-282) to 109 (33-262) mg/24 h with hydrochlorothiazide (analysis of variance, p = 0.0436). During the last three months of treatment with enalapril five patients had persistent normoalbuminuria (2-3 times below 30 mg/24 h), five low microalbuminuria, and one high microalbuminuria; in the hydrochlorothiazide group one had normoalbuminuria, three low microalbuminuria, and six high microalbuminuria (chi 2 test = 6.7; p = 0.03). Mean arterial pressure did not differ before (98 (SD 7) with enalapril v 97 (9) mm Hg with hydrochlorothiazide) or during treatment (88 (7) with enalapril v 90 (7) mm Hg with hydrochlorothiazide (analysis of variance, p = 0.5263)). Glomerular filtration rate did not vary. The aldosterone to active renin ratio was decreased by angiotensin I converting enzyme inhibition and increased by sodium depletion, showing treatment efficacy.
conclusionAngiotensin I converting enzyme inhibition by enalapril effectively reduces microalbuminuria in normotensive diabetic patients whereas hydrochlorothiazide is not effective. Changes in blood pressure and activity of the renin-angiotensin-aldosterone system may contribute to these different effects.
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