Abstract
Background
There is a lack of research on the effect of low dose of angiotensin receptor blockers
combined with spironolactone, and the effect of high dose of angiotensin receptor
blockers alone on the urinary albumin excretion rate (UAER) in elderly patients with
early type 2 diabetic nephropathy (DN).
Methods
We conducted a prospective, randomized, open-label, parallel-controlled study that
included 244 elderly patients with early DN and mild-to-moderate essential hypertension.
Patients were randomly divided into 4 groups: low-dose irbesartan (group A), high-dose
irbesartan (group B), low-dose irbesartan combined with spironolactone (group C) and
high-dose irbesartan combined with spironolactone (group D). Changes in UAER, serum
potassium and blood pressure were compared.
Results
There were no statistical differences in the baseline characteristics among groups.
Furthermore, no significant difference in blood pressure before and after treatment
was found among different groups. After 72-week treatment, UAER in group D was lower
compared to group A and B (P < 0.05). Meanwhile, compared with group B, UAER in group C decreased significantly
(P < 0.05). Additionally, significantly higher serum potassium was found in group D
compared to other groups (P < 0.05). Also, group D had the highest count of patients who withdrew from the study
due to hyperkalemia compared to other groups (P < 0.05).
Conclusions
Our results indicate high-dose irbesartan combined with spironolactone may be more
efficient in reducing UAER in elderly patients with early DN, but this treatment could
cause hyperkalemia. Low-dose irbesartan combined with spironolactone was shown to
be safer and more effective in decreasing UAER compared to high-dose irbesartan.
Key Indexing Terms
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Article info
Publication history
Accepted:
January 30,
2018
Received in revised form:
January 27,
2018
Received:
September 6,
2017
Footnotes
☆This study was supported by Shandong Province Medical and Health Technology Development Program (No. 2016WS0193).
☆☆The authors have no conflicts of interest to disclose.
Y.C and P.L contributed equally to this study.
Identification
Copyright
© 2018 Southern Society for Clinical Investigation. Published by All rights reserved.
