Olmesartan推迟或预防2型糖尿病患者微蛋白尿。

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Izzo小杰哈勒H, Ito年代,Januszewicz A片,梅恩J, Mimran, Rabelink TJ,丽兹E, Ruilope LM,臀部LC, Viberti G

Olmesartan推迟或预防2型糖尿病患者微蛋白尿。

郑传经地中海J。2011年3月10日,364(10):907 - 17所示。doi: 10.1056 / NEJMoa1007994。

PubMed ID

21388309 (在PubMed

]

文摘

背景:微量白蛋白尿是糖尿病肾病的早期预测心血管疾病和过早。我们调查是否治疗与血管紧张素受体阻滞剂(ARB)将延迟或防止微蛋白尿的发生所料在2型糖尿病患者和正常蛋白尿。方法:在一个随机、双盲、多中心、对照试验中,我们指定4447名2型糖尿病患者olmesartan(40毫克的剂量每日一次)或安慰剂的平均3.2年。额外的抗高血压药物(血管紧张素转换酶抑制剂或arb除外)被用作需要降低血压130/80毫米汞柱,主要结果是第一微蛋白尿的发病时间。《纽约时报》分析了肾和心血管事件的发生作为次要终点。结果:目标血压(< 130/80毫米汞柱)实现了近80%的病人服用olmesartan和服用安慰剂71%;在诊所血压测量低3.1/1.9毫米汞柱olmesartan组比安慰剂组。微蛋白尿发展olmesartan组中8.2%的患者(178 2160)可以评估病人9.8%,安慰剂组(210 2139);时间微蛋白尿的发病与olmesartan增加了23%(微蛋白尿的发病风险比,0.77;95%置信区间,0.63 - 0.94; P=0.01). The serum creatinine level doubled in 1% of the patients in each group. Slightly fewer patients in the olmesartan group than in the placebo group had nonfatal cardiovascular events--81 of 2232 patients (3.6%) as compared with 91 of 2215 patients (4.1%) (P=0.37)--but a greater number had fatal cardiovascular events--15 patients (0.7%) as compared with 3 patients (0.1%) (P=0.01), a difference that was attributable in part to a higher rate of death from cardiovascular causes in the olmesartan group than in the placebo group among patients with preexisting coronary heart disease (11 of 564 patients [2.0%] vs. 1 of 540 [0.2%], P=0.02). CONCLUSIONS: Olmesartan was associated with a delayed onset of microalbuminuria, even though blood-pressure control in both groups was excellent according to current standards. The higher rate of fatal cardiovascular events with olmesartan among patients with preexisting coronary heart disease is of concern. (Funded by Daiichi Sankyo; ClinicalTrials.gov number, NCT00185159.).

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药物

Olmesartan