Further detailed analysis of the ADVANCE trial data has indicated that lower achieved follow-up systolic BP levels were associated with progressively lower renal event rates to below CHIR-99021 supplier 110 mm Hg.68 Renoprotective effects of

blood pressuring lowering with perindopril indapamide treated were noted even among the sub group with baseline BP below 120/70 mm Hg. An open label parallel prospective randomized trial provides a comparison of the effects of a ARB (losartan) and a CCB (amlidopine) on the UAE and ACR of 87 hypertensive type 2 diabetes Japanese patients with persistent macroalbuminuria.79 The ARB and CCB treatments provided similar BP control (no significant difference). The ARB treatment resulted in a 30% drop in the UAE after 6 months treatment and a 16% drop in the ACR. There was no significant change in both the UAE and the ACR in the CCB treatment. In relation to ACEi, a number of additional trials have been identified, the details and findings of which are summarized in Table A3.80–83 While the study summarized in Table A10 has examined both ACEi and ARBs either alone of in combination.84

LY294002 mw A number of studies have specifically assessed the ARB valsartan.85–90 The details and findings of these studies are summarized in Table A3 below. Overall, the studies are consistent with the renoprotective effect of ARBs, however, they do not provide additional data allowing a direct comparison with ACEi. The BENDICT Trial was a long-term (median 43 months) prospective multicentre RCT of 1204 people with type 2 diabetes, elevated BP and normoalbuminuria.91,92 The trial was aimed at assessing the efficacy of ACEi and CCB alone and in combination. Additional agents were permitted to achieve appropriate BP control. Trandolapril plus verapamil and trandolapril alone decreased the incidence of microalbuminuria ID-8 to similar extent. Verapamil alone was found to be no different to the placebo. The comparative effects of HCT, ACEi and ARB on UAE (as a secondary outcome) were assessed in 70 people with type 2 diabetes in the

Netherlands.93 The people with type 2 diabetes were Caucasian with an average age in the randomized treatment groups of 60–63, hypertensive and either normoalbuminuric or early microalbuminuric (UAE < 100 mg/day). The trial was of 12 months duration after a 1 month run in and a 4–6 month BP titration period. All three agents achieved the aggressive BP goals equally well in the three treatment groups. The UAE was reduced by around 35% over 12 months and there was no significant difference between the three treatments. The authors note that this outcome may reflect the relatively small sample size. This additional ACEi/ARB comparative study from those reported does not provide additional evidence for the efficacy of ARB compared with ACEi in achieving regression of microalbuminuria.