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Enalapril and losartan reduce retinopathy progression in Type 1 diabetics
2 July 2009
MedWire News: Treatment with the renin-angiotensin system blockers enalapril and losartan slows the progression of retinopathy, but not nephropathy, in patients with Type 1 diabetes, report researchers.
Results from previous studies have suggested that use of renin-angiotensin system blockers, as opposed to other antihypertensive drugs, may slow or stop progression of diabetic nephropathy and retinopathy.
To test this further, Michael Mauer (University of Minnesota, Minneapolis, USA) and colleagues recruited 285 normotensive individuals with Type 1 diabetes to take part in the Renin-Angiotensin System Study (RASS).
The participants were randomly assigned to take the angiotensin receptor blocker losartan 100 mg/day (n=96), the angiotensin-converting enzyme inhibitor enalapril 20 mg/day (n=94), or placebo (n=95) for a period of 5 years.
Writing in the New England Journal of Medicine, the team reports that the change in the mesangial fractional volume per glomerulus (measure of nephropathy) over the 5-year period did not change significantly among the three groups at 0.016, 0.005, and 0.026 units in the placebo, enalapril, and losartan groups, respectively.
However, when compared with placebo, the odds for retinopathy progression of two steps or more over the 5-year period were reduced by 65% with enalapril and 70% with losartan, independently of changes in blood pressure.
Serious adverse events were minimal and similar among the groups. Chronic cough was slightly more common in the enalapril and losartan groups (12 and 6 patients, respectively) compared with placebo (4 patients).
Lloyd Aiello, from Harvard Medical School in Boston, USA, and co-authors of an accompanying editorial commented: “Although inhibition of the renin–angiotensin system is clearly effective in the study by Mauer et al, further work is required before the strategy is used for retinopathy prevention in clinical practice.”
Commenting on the negative results for nephropathy, Mauer said: "Although neither medication delayed early kidney tissue injury or early loss of kidney function, the advantage to a study with negative findings such as this one is that physicians now know that this treatment is ineffective for this purpose, and they can pursue other treatment options that may improve their patients' outcomes."
