AUTHOR | STUDY POPULATION | STUDY SIZE/ DURATION | RESULTS |
---|---|---|---|
Mogensen et al. Br Med J 1982 [6] | Type I DM Mean BP 162/103 Urinary albumin 3.9 g/d GFR 86 ml min-1 1.73 m2-1 | N = 5 73 month treatment period compared to previous 20–31 month untreated period | BP decreased to 144/95 mmHg with treatment Rate of decline of GFR decreased from 14.8 to 5.9 ml min-1 yr-1 in treated period |
Parving et al. Lancet 1983 [7] | Type I DM Mean BP 144/97 mmHg Proteinuria > 0.5 g/d GFR approx 77 ml min-1 1.73 m2-1 | N = 10 39 month treatment period compared to 29 month untreated period | BP decreased to 128/84 mmHg with treatment Rate of decline of GFR decreased from 0.9 to 0.39 ml min-1 mo-1 in treated period |
Bjorck et al. Br Med J 1986 [8] | Type I DM Mean BP 163/97 mmHg Mean proteinuria 2.9 g/d Mean serum Cr 2.1 | N = 14 4.8 yrs (2.8 yrs untreated followed by 2 yrs treated with captopril) | BP decreased to 155/94 mmHg with treatment (p < 0.02) Urinary protein decreased from 2.9 to 2.8 (NS) Rate of decline of GFR decreased from 10.3 to 5.5 ml min-1 yr-1 (p < 0.02) |
Parving et al. Br Med J 1987 [9] | Type I DM > 200 ug/min albuminuria BP 143/96 mmHg pre-treatment Mean GFR approx. 103 ml min-1 1.73 m2-1 | N = 11 32 mo. untreated followed by 6 yrs treated) | BP decreased to 129/84 mmHg with treatment (p < 0.01) Albuminuria decreased from 1038 to 504 ug/min (p < 0.01) Rate of decline of GFR decreased from 0.89 to 0.22 ml-1 min-1 mo-1 during treatment (p < 0.01) |
Parving et al. BMJ 1988 [10] | Type I DM treated with captopril or placebo > 0.3 g/d albumin (mean approx. 0.95) Baseline BP 146/93 mmHg and 137/95 mmHg in 2 groups, respectively Serum Cr < 120 μmol/L GFR mean approx. 97 ml min-1 1.73 m2-1 | N = 31 Captopril (N = 18) Control (N = 13) 2.5 yrs | MAP decreased by 8.7 mmHg to 136/85 by captopril; increased by 6.6 mmHg to 145/98 mmHg in controls (p < 0.001) Albumin excretion decreased to 390 ug/min in captopril, increased to 1367 ug/min in controls (p < 0.001) GFR decline 5.8 ml min-1 yr-1 in captopril vs. 10 ml min-1 yr-1 in controls (p < 0.01) |
Sawicki et al J Diabetes Complications 1995 [11] | Type I DM Proteinuria > 0.5 g/d Serum Cr < 265 μmol/L Diabetic retinopathy BP > 140/90 mmHg or need for BP meds Intensive treatment including BP self-monitoring with goal BP < 140/90 mmHg (IT) vs. routine treatment (RT) | N ~ 100 5 yrs | Primary study endpoints (need for dialysis or death) decreased in IT group |
UKPDS 38 1998 13 | Type II DM Serum Cr < 177 μmol/L BP <150/85 mmHg vs. < 180/105 mmHg | N = 31 with overt nephropathy (> 300 mg/l albuminuria) 8.4 yrs | Insufficient numbers to determine if BP control benefitted patients with overt nephropathy (P = 0.06) |
Trocha et al. J Hypertension 1999 [12] | Type I DM Proteinuria > 0.5 g/d Cr < 265 μmol/L Diabetic retinopathy BP > 140/90 mmHg or need for BP meds BP self-monitoring with goal BP < 140/90 (IT) vs. routine care (RT) | N = 91 IT (N = 45) RT (N = 46) 10 yrs | Primary study endpoints (need for dialysis or death) decreased in IT group |
Lewis et al. Am J Kidney Dis 1999 [14] | Type I DM with overt nephropathy Serum Cr < 354 μmol/L MAP of 92 mmHg (Group I) vs. 102–107 mmHg (Group II) | N = 129 N = 63 in Group I N = 66 in Group II 2 yrs | MAP 92 mmHg in Group I vs. 98 in Group II No significant difference in rate of decline of GFR Significant decrease in albuminuria in intensive group |
Estacio et al. Diabetes Care 2000 [15] | Type II DM DBP > 90 mmHg CCr of 76 ml min-1 1.73 m2-1 Randomized to intensive therapy (IT) (DBP < 75 mmHg) or moderate therapy (MT) (DBP 80–89 mmHg) | N = 470 total N = 83 with overt proteinuria 5 yrs | BP decreased significantly with IT vs. MT (132/78 mmHg vs. 138/86 mmHg) Pts with overt albuminuria demonstrated a steady decline in creatinine clearance of 5–6 ml min-1 1.73 m2-1 yr-1 throughout the follow-up period in both IT and MT groups (pNS) |