Albuminuria response to very high-dose valsartan in type 2 diabetes mellitus

Norman K. Hollenberg, Hans Henrik Parving, Giancarlo Viberti, Giuseppe Remuzzi, Susan Ritter, Steven Zelenkofske, Albert Kandra, William L. Daley, Ricardo Rocha

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Renin-angiotensin system blockade is now standard in the management of the patient with type 2 diabetes mellitus. We aimed to investigate whether high doses of valsartan, an angiotensin receptor blocker, are superior to conventional doses to reduce urinary albumin excretion rates (UAER) in such patients. PATIENTS AND METHODS: Three hundred and ninety-one hypertensive patients with type 2 diabetes mellitus and UAER 20-700 μg/min were randomized to 160, 320 or 640 mg valsartan. All received valsartan 160 mg for the first 4 weeks. Valsartan dose was then increased in two of three groups for 30 weeks. Overnight urine collections at baseline, 4, 16, and 30 weeks in triplicate were used to assess proteinuria. RESULTS: Comparable albuminuria reductions occurred in all groups at week 4 (P <0.001). Subsequently, a highly significant albuminuria fall occurred with valsartan 320 and 640 mg (P <0.001) versus a modest additional change with 160 mg (P = 0.03). At week 30, twice as many patients returned to normal albuminuria with valsartan 640 mg versus 160 mg (24 versus 12%; P <0.01). High doses were well tolerated, with no dose-related increases in adverse events, including hypotension and hyperkalemia. CONCLUSION: High doses of valsartan reduced albuminuria more than the more commonly used 160 mg dose, apparently independent of blood pressure. Thus, at least in type 2 diabetes mellitus, higher doses of valsartan are required to optimize tissue protection than for blood pressure control.

Original languageEnglish
Pages (from-to)1921-1926
Number of pages6
JournalJournal of Hypertension
Volume25
Issue number9
DOIs
Publication statusPublished - Sep 2007

Fingerprint

Valsartan
Albuminuria
Type 2 Diabetes Mellitus
Albumins
Blood Pressure
Urine Specimen Collection
Hyperkalemia
Angiotensin Receptor Antagonists
Renin-Angiotensin System
Proteinuria
Hypotension

Keywords

  • Angiotensin receptor blockade
  • Diabetes
  • Nephropathy

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology

Cite this

Hollenberg, N. K., Parving, H. H., Viberti, G., Remuzzi, G., Ritter, S., Zelenkofske, S., ... Rocha, R. (2007). Albuminuria response to very high-dose valsartan in type 2 diabetes mellitus. Journal of Hypertension, 25(9), 1921-1926. https://doi.org/10.1097/HJH.0b013e328277596e

Albuminuria response to very high-dose valsartan in type 2 diabetes mellitus. / Hollenberg, Norman K.; Parving, Hans Henrik; Viberti, Giancarlo; Remuzzi, Giuseppe; Ritter, Susan; Zelenkofske, Steven; Kandra, Albert; Daley, William L.; Rocha, Ricardo.

In: Journal of Hypertension, Vol. 25, No. 9, 09.2007, p. 1921-1926.

Research output: Contribution to journalArticle

Hollenberg, NK, Parving, HH, Viberti, G, Remuzzi, G, Ritter, S, Zelenkofske, S, Kandra, A, Daley, WL & Rocha, R 2007, 'Albuminuria response to very high-dose valsartan in type 2 diabetes mellitus', Journal of Hypertension, vol. 25, no. 9, pp. 1921-1926. https://doi.org/10.1097/HJH.0b013e328277596e
Hollenberg, Norman K. ; Parving, Hans Henrik ; Viberti, Giancarlo ; Remuzzi, Giuseppe ; Ritter, Susan ; Zelenkofske, Steven ; Kandra, Albert ; Daley, William L. ; Rocha, Ricardo. / Albuminuria response to very high-dose valsartan in type 2 diabetes mellitus. In: Journal of Hypertension. 2007 ; Vol. 25, No. 9. pp. 1921-1926.
@article{f0f2e6c8335a4209a03e4fa538e8ec11,
title = "Albuminuria response to very high-dose valsartan in type 2 diabetes mellitus",
abstract = "OBJECTIVE: Renin-angiotensin system blockade is now standard in the management of the patient with type 2 diabetes mellitus. We aimed to investigate whether high doses of valsartan, an angiotensin receptor blocker, are superior to conventional doses to reduce urinary albumin excretion rates (UAER) in such patients. PATIENTS AND METHODS: Three hundred and ninety-one hypertensive patients with type 2 diabetes mellitus and UAER 20-700 μg/min were randomized to 160, 320 or 640 mg valsartan. All received valsartan 160 mg for the first 4 weeks. Valsartan dose was then increased in two of three groups for 30 weeks. Overnight urine collections at baseline, 4, 16, and 30 weeks in triplicate were used to assess proteinuria. RESULTS: Comparable albuminuria reductions occurred in all groups at week 4 (P <0.001). Subsequently, a highly significant albuminuria fall occurred with valsartan 320 and 640 mg (P <0.001) versus a modest additional change with 160 mg (P = 0.03). At week 30, twice as many patients returned to normal albuminuria with valsartan 640 mg versus 160 mg (24 versus 12{\%}; P <0.01). High doses were well tolerated, with no dose-related increases in adverse events, including hypotension and hyperkalemia. CONCLUSION: High doses of valsartan reduced albuminuria more than the more commonly used 160 mg dose, apparently independent of blood pressure. Thus, at least in type 2 diabetes mellitus, higher doses of valsartan are required to optimize tissue protection than for blood pressure control.",
keywords = "Angiotensin receptor blockade, Diabetes, Nephropathy",
author = "Hollenberg, {Norman K.} and Parving, {Hans Henrik} and Giancarlo Viberti and Giuseppe Remuzzi and Susan Ritter and Steven Zelenkofske and Albert Kandra and Daley, {William L.} and Ricardo Rocha",
year = "2007",
month = "9",
doi = "10.1097/HJH.0b013e328277596e",
language = "English",
volume = "25",
pages = "1921--1926",
journal = "Journal of Hypertension",
issn = "0263-6352",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - Albuminuria response to very high-dose valsartan in type 2 diabetes mellitus

AU - Hollenberg, Norman K.

AU - Parving, Hans Henrik

AU - Viberti, Giancarlo

AU - Remuzzi, Giuseppe

AU - Ritter, Susan

AU - Zelenkofske, Steven

AU - Kandra, Albert

AU - Daley, William L.

AU - Rocha, Ricardo

PY - 2007/9

Y1 - 2007/9

N2 - OBJECTIVE: Renin-angiotensin system blockade is now standard in the management of the patient with type 2 diabetes mellitus. We aimed to investigate whether high doses of valsartan, an angiotensin receptor blocker, are superior to conventional doses to reduce urinary albumin excretion rates (UAER) in such patients. PATIENTS AND METHODS: Three hundred and ninety-one hypertensive patients with type 2 diabetes mellitus and UAER 20-700 μg/min were randomized to 160, 320 or 640 mg valsartan. All received valsartan 160 mg for the first 4 weeks. Valsartan dose was then increased in two of three groups for 30 weeks. Overnight urine collections at baseline, 4, 16, and 30 weeks in triplicate were used to assess proteinuria. RESULTS: Comparable albuminuria reductions occurred in all groups at week 4 (P <0.001). Subsequently, a highly significant albuminuria fall occurred with valsartan 320 and 640 mg (P <0.001) versus a modest additional change with 160 mg (P = 0.03). At week 30, twice as many patients returned to normal albuminuria with valsartan 640 mg versus 160 mg (24 versus 12%; P <0.01). High doses were well tolerated, with no dose-related increases in adverse events, including hypotension and hyperkalemia. CONCLUSION: High doses of valsartan reduced albuminuria more than the more commonly used 160 mg dose, apparently independent of blood pressure. Thus, at least in type 2 diabetes mellitus, higher doses of valsartan are required to optimize tissue protection than for blood pressure control.

AB - OBJECTIVE: Renin-angiotensin system blockade is now standard in the management of the patient with type 2 diabetes mellitus. We aimed to investigate whether high doses of valsartan, an angiotensin receptor blocker, are superior to conventional doses to reduce urinary albumin excretion rates (UAER) in such patients. PATIENTS AND METHODS: Three hundred and ninety-one hypertensive patients with type 2 diabetes mellitus and UAER 20-700 μg/min were randomized to 160, 320 or 640 mg valsartan. All received valsartan 160 mg for the first 4 weeks. Valsartan dose was then increased in two of three groups for 30 weeks. Overnight urine collections at baseline, 4, 16, and 30 weeks in triplicate were used to assess proteinuria. RESULTS: Comparable albuminuria reductions occurred in all groups at week 4 (P <0.001). Subsequently, a highly significant albuminuria fall occurred with valsartan 320 and 640 mg (P <0.001) versus a modest additional change with 160 mg (P = 0.03). At week 30, twice as many patients returned to normal albuminuria with valsartan 640 mg versus 160 mg (24 versus 12%; P <0.01). High doses were well tolerated, with no dose-related increases in adverse events, including hypotension and hyperkalemia. CONCLUSION: High doses of valsartan reduced albuminuria more than the more commonly used 160 mg dose, apparently independent of blood pressure. Thus, at least in type 2 diabetes mellitus, higher doses of valsartan are required to optimize tissue protection than for blood pressure control.

KW - Angiotensin receptor blockade

KW - Diabetes

KW - Nephropathy

UR - http://www.scopus.com/inward/record.url?scp=34548444609&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34548444609&partnerID=8YFLogxK

U2 - 10.1097/HJH.0b013e328277596e

DO - 10.1097/HJH.0b013e328277596e

M3 - Article

C2 - 17762658

AN - SCOPUS:34548444609

VL - 25

SP - 1921

EP - 1926

JO - Journal of Hypertension

JF - Journal of Hypertension

SN - 0263-6352

IS - 9

ER -