The Therapy Of Microalbuminuric Patients With Type 2 Diabetes Mellitus And Hypertension

BackgroundDiabetes mellitus(DM) is intimately related with a range of cardiovascular diseases,and acute cardiovascular events and total deaths of half of diabetic patients were increased by 3～4 times because of diabetes mellitus(DM).It has been shown that the intensive treatment of hyperglycosemia,hypertension and dyslipidemia of the patients with diabetes mellitus and hypertension can reduce cardiovascular disease morbidity and mortality.The prevalence rate of adult diabetes is growing in the world. It is estimated according to WHO that there are about 175 million diabetic patients currently,to reach 300 million in 2025.The United States National Health and Nutrition Examination Survey(NHANES) show that the prevalence rate of diabetes was 5.1%from 1988 to 1994,from 1999 to 2002 to reach 6.5%,and from 2003 to 2006 increased 7.8%.Type 2 diabetes mellitus is oriented in China's population,and it is accounting for 93.7 percent of diabetes.The incidence of hypertension in diabetic patients was as high as 70%,particularly older patients and male patients.High blood pressure was accounted for 35%～45%of cardiovascular and renal complications in the diabetic population,and the absolute benefit of lowering blood pressure was greater than non-diabetic population.Chronic kidney disease can be induced by diabetes mellitus and hypertension,the combined effect of both accelerated kidney damage.Microalbuminuria is one of the early markers of renal damage,diabetic nephropathy may be microalbuminuda,renal damage of hypertension may be the same protein in urine.Accordingly,it is to investigate the effects of microalbuminuria of patients with diabetes mellitus and hypertension using three drug combination therapy.ObjectiveTo delineate the speculation that triple combination of small doses of calcium antagonist(levoamlodipine),ACEI(imidapril) and ARB(candesartan) may exert more significantly effect on microalbuminuria(MAU) in patients with type 2 of diabetes mellitus and hypertension.MethodsOne hundred sixty cases of consecutive patients with type 2 diabetes mellitus and hypertension were randomized to receive following various combinations: amlodipine 2.5 mg/candesartan 4 mg(n=40),candesartan 4 mg/imidapril 5 mg (n=40);imidapril 5 mg/ amlodipine 2.5 mg(n=40),and amlodipine 2.5 mg/ candesartan 4 mg plus imidapril 5 mg(n=40).The course of treatment is about three months.The changes in blood pressure and MAU were determined before and after treatment.Blood pressure was measured three consecutive times,one minute in apart, in the sitting position using an appropriate cuff size.The mean values of the last two measurements was calculated and used in the analysis.The antihypertensive medications were given to the patients at the end of the examination.The purpose of the study was clearly explained to all subjects,who then volunteered to participate.ResultsFour drug combinations of treatment all significantly lowered BP(p＜0.05),with no significantly statistical difference among the all various combination treatments decreased urine MAU(p＜0.01),however the 3 drugs combination treatment group decreased MAU more significantly than those by 2 drugs combination treatments (p＜0.05).However,after treatment of blood pressure among the four groups were showed no significant statistical difference. ConclusionSmall dose of triple drugs combination(candesartan,imidapril and levoamlodipine) is more effective in improving early renal damage of patients with diabetes mellitus and hypertension than that by 2 drugs combination.It is prompted that the early renal damage in patients with diabetes mellitus and hypertension should be united antihypertensive treatment as soon as possible.