Telmisartan is more effective than losartan in reducing proteinuria in patients with diabetic nephropathy

• Published in: Kidney international Vol. 74; no. 3; pp. 364 - 369
• Main Authors: Bakris, George, Burgess, Ellen, Weir, Matthew, Davidai, Giora, Koval, Stephen
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-08-2008; Nature Publishing; Elsevier Limited
• Subjects: Aged; Albuminuria - urine; Angiotensin II Type 1 Receptor Blockers - therapeutic use; angiotensin receptor blockers; Benzimidazoles - pharmacokinetics; Benzimidazoles - standards; Benzimidazoles - therapeutic use; Benzoates - pharmacokinetics; Benzoates - standards; Benzoates - therapeutic use; Biological and medical sciences; Blood Pressure - drug effects; Creatinine - urine; Diabetic Nephropathies - drug therapy; Diabetic Nephropathies - pathology; Double-Blind Method; Female; Half-Life; Humans; Hypertension; Kidneys; losartan; Losartan - pharmacokinetics; Losartan - standards; Losartan - therapeutic use; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; proteinuria; Proteinuria - drug therapy; Proteinuria - prevention & control; telmisartan; type-2 diabetes; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; angiotensin receptor blockers; losartan; telmisartan; type-2 diabetes; proteinuria; Endocrinopathy; Type 2 diabetes; Imidazole derivatives; Tetrazole derivatives; Nephrology; Peptide hormone; Non peptide compound; Urology; Octapeptide; Efficiency; Losartan; Diabetic nephropathy; Angiotensin II; Kidney disease; Human; Urinary system disease; Metabolic diseases; Angiotensin receptor; Telmisartan; Concomitant disease; Renin angiotensin system; Benzimidazole derivatives; Biphenyl derivatives; Antihypertensive agent; Sartan derivatives; Angiotensin antagonist; Proteinuria
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/ki.2008.204

In patients with diabetic nephropathy, lowering blood pressure and reducing proteinuria by over 30% correlates with a slower progression to kidney failure. We compared two different angiotensin receptor-blockers in a double blind, prospective trial of 860 patients with type 2 diabetes whose blood pressure levels was over 130/80mmHg or who were receiving antihypertensive medication(s) and who had a morning spot urinary protein to creatinine ratio of 700 or more. Patients were randomized to telmisartan (a highly lipophilic agent with a long half-life) or losartan (with low lipophilicity and short half-life). The primary endpoint was the difference in the urinary albumin to creatinine ratio between the groups at 52 weeks. The geometric coefficient of variation and the mean of the urinary albumin to creatinine ratio fell in both groups at 52 weeks but both were significantly greater for the telmisartan compared to the losartan cohort. Mean systolic blood pressure reductions were not significantly different between groups at trial end. We conclude that telmisartan is superior to losartan in reducing proteinuria in hypertensive patients with diabetic nephropathy, despite a similar reduction in blood pressure.