Spironolactone further reduces urinary albumin excretion and plasma B-type natriuretic peptide levles in hypertensive type II diabetes treated with angiotensin-converting enzyme inhibitor

Susumu Ogawa, Kazuhisa Takeuchi, Takefumi Mori, Kazuhiro Nako, Sadayoshi Ito

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

1. Over the course of treatment with angiotensin-converting enzyme inhibitor (ACEI), plasma levels of aldosterone have been shown to increase and this increase would blunt the effectiveness of the ACEI (aldosterone escape phenomenon). 2. In the present study, we assessed a potential renal benefit of additional aldosterone blockade with spironolactone in hypertensive diabetic patients treated with ACEI showing the phase of aldosterone escape. 3. The present clinical study was a randomized prospective study to assess difference between the clinical effects of spironolactone and furosemide. Thirty hypertensive type II diabetics (DM2) with a urinary alubumin : creatinine ratio (ACR) above 30 mg/g creatinine (showing albuminuria) and plasma B-type natriuretic peptide (BNP) levels above 100 pg/mL (showing mild heart failure) were treated with an ACEI (imidapril 5 mg/day) for 1 year and then randomly divided into two groups, one group receiving additional spironolactone (25 mg/day) treatment and the other receiving furosemide (20 mg/day) treatment. Blood pressure, ACR and plasma BNP levels were monitored in both groups. 4. Treatment with the ACEI reduced ACR initially but, in 1 year, ACR tended to increase. Additional spironolactone treatment progressively reduced ACR, whereas furosemide treatment did not show any effect. Plasma BNP levels were reduced by ACEI and were further reduced by additional spironolactone treatment, but not furosemide treatment. Blood pressure levels in both groups were comparable. 5. In conclusion, additional therapy with spironolactone in ACEI treatment exerts a renoprotective, as well as cardioprotective, effect in hypertensive diabetes.

Original languageEnglish
Pages (from-to)477-479
Number of pages3
JournalClinical and Experimental Pharmacology and Physiology
Volume33
Issue number5-6
DOIs
Publication statusPublished - 2006 May 1

Keywords

  • Albuminuria
  • Aldosterone escape
  • Angiotensin-converting enzyme inhibitor
  • B-type natriuretic peptide
  • Diabetic nephropathy
  • Furosemide
  • Hypertensive type II diabetes
  • Spironolactone

ASJC Scopus subject areas

  • Physiology
  • Pharmacology
  • Physiology (medical)

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