Impediment of the Progressions of Microalbuminuria and Hyperlipidemia in Normotensive Type 2 Diabetes by Low-Dose Ramiprilt
SOMBOON VONGTERAPAK, M.D.*, SOONTAREE NAKASATIEN, B.Sc.*, MONTA SUPPANICH, B.Sc.*, CHANIKA SURASINGCHAIDET, B.Sc.*, MAYURA TEPKASETKUL, M.D.*, BOONSONG ONGPHIPHADHANAKUL, M.D.***, THEP HIMATHONGKAM,M.D.*. WINAI DAHLAN, Ph.D.**, TA WEE ANUNTAKULNATEE, M.D.*, WORA WIT KITTIPOOM, M.D. *, CHATTIP TAMWIWAT, M.D.*, PONGAMORN BUNNAG, M.D.***, RAJATA RAJATANAVIN, M.D.***,
Affiliation : * Theptarin General Hospital, Bangkok 10110, ** Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok 10330, *** Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. t This work was partially supported by grant from Hoechst Marion Roussel and was presented at the 13th Congress of the Royal College of Physicians of Thailand, Chiang Mai, Thailand, 22-24 April 1997.
In a randomized, double-blind, placebo-controlled study, we investigated in normoten- sive type 2 diabetics with rnicroalbuminuria the effect of ramipril, an ACE inhibitor, on urine albumin excretion and serum lipids. A total of 1,882 patients were screened for urine micro- albumin consecutively by dipstick test, Rapi Tex®-Albumin test and RIA. The final 28 normo- tensive and microalbuminuric patients were assigned to receive either ramipril (1.25 mg/d, n=l6) or placebo (n=l2) for 12 weeks. Throughout the study, both groups had no changes in blood pressure, fasting plasma glucose, HbAlC• serum creatinine and electrolytes and no dif- ference in creatinine clearance. At week 12 only the placebo group showed the significant incre- ment of urine albumin excretion and triacylglycerol (30.6±38.3 to 39.0±19.7 and 167±64 to 208±77 mg/dl, respectively) but the decrement of HDL-cholesterol (46±16 to 35±6 mg/dl). During a 3 month period, increased urine albumin excretion was observed in normotensive type 2 diabetes with microalbuminuria who received only placebo. We conclude that ramipril may arrest the progression of albumin excretion and had favorable effects on serum lipids. Ramipril was safe and well-tolerated without untoward side effects during the study period.
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