Irbesartan Reduces the Albumin

Excretion Rate in Microalbuminuric

Type 2 Diabetic Patients
Independently of Hypertension
Sasso FC, Carbonara O, Persico M,
Lafusco D ,Salvatore T, DAmbrosio R et.al
1

1.

5501280364

2.

5501280401

3.

5501280418

4.

5501280425

5.

5501280432

6.

5501280449

7. 5501280456

1.

ACE inhibitor
albumin(Albumin excretion rate ;AER)

Angiotensin II type1 receptor antagonist

microalbuminuria mean arterial pressure.
2.
Irbesartan microalbumin mean
arterial pressure 2

3.
1 64 microalbuminuric hypertensive 2
60 microalbuminuric normotensive , BMI,
HbA1c
Irbesartan (150 mg. b.i.d. orally ) placebo
60 15
randomized double-blind crossover study

4.

microalbuminuric hypertensive 2
Irbesartan systolic , diastolic AER

microalbuminuric normotensive 2
Irbesartan AER
5.
Irbesartan
AER 2

Irbesatarn
microalbuminurea (AER )
2

1.
2.
3.

1.

2.

2 carryover effect
(Washout )
2

(compliance)

3.

(
parallel )

4. RCT

cross-over
RCT
(Experimental design)

10

1.

2. Renin angiotensin system (RAS)

3. ACE inhibitor AER (Albumin excretion rate)

RAS.
ACEIs

4. Irbesartan angiotensin ll type1

receptor (AT1RA) angiotensin
ACEIs
metabolic
RAS aldosterone,
catecholamine vasopressin
11

5.

The primary end point Albumin excretion rate

The secondary end point
systolic diastolic blood pressure
6.

12

6.

Metabolic
disease
3

microalbuminuria
metabolic
HbA1c
80
79 (<140/90 mmHg)

mild-moderate (diastolic BP
90 mmHg and <110 mmHg, systolic BP 140 and <180
mmHg)
AER ( overnight
urine 3 6 )
24 Holter ( Welch Allyn
/ Tycos , Arden , NC )
13

6.

, (creatinine clearance
<80 ml/min / serum creatinine 106 mmol/l
[1.2 mg/dl])

serum potassium >5.0 mmol/l

(electrocardiogram signs )

acute or severe chronic liver disease
autonomic neuropathy ( (assessed by the
heart rate responses to deep breathing, to Valsalva
maneuver, and to standing and by the BP response to
standing, according to age-related normal ranges)
14

 Metabolic
disease 3 2

(159 )

7.

60

64

32

32

(35)

30

30

15

16

8. Figure2 : A (normotensive)
Irbesartan AER B (hypertension)
normotensive
2

Figure 2AER in the two

subgroups of normotensive
(A) and hypertensive (B)
diabetic subjects.
*P < 0.01.

17

Result

microalbuminuric hypertensive 2 Irbesartan

systolic , diastolic AER
microalbuminuric normotensive 2
Irbesartan AER
18