-
Views
-
Cite
Cite
George L. Bakris, David S.H. Bell, Vivian Fonseca, Richard E. Katholi, Janet B. McGill, Franz H. Messerli, Robert A. Phillips, Philip Raskin, Jackson T. Wright, Mary Ann Lukas, Karen M. Anderson, Brian Waterhouse, P-222: Differential effects of β-blockers in combination with renin angiotensin system blockers on microalbuminuria in patients with type 2 diabetes and hypertension, American Journal of Hypertension, Volume 18, Issue S4, May 2005, Page 86A, https://doi.org/10.1016/j.amjhyper.2005.03.239
Close - Share Icon Share
Abstract
Presence of microalbuminuria [(MAU), urine albumin:creatinine ratio (ACR) 30–300 mg/g], in patients (pts) with hypertension (HTN) and type 2 diabetes (T2DM) is associated with a high risk of cardiovascular events. The effect of addition of a β-blocker to an ACE or ARB on ACR in pts with HTN and T2DM was a pre-specified secondary endpoint of the GEMINI trial. Metoprolol [(M), 50–200 mg bid] was compared to carvedilol [(C), 6.25–25 mg bid] on change in ACR. After wash-out of all antihypertensive medications except ACE/ARB pts were randomized (C:498;M:737; double-blinded), titrated to target BP (<130/80 mmHg) and followed for 5 months. Hydrochlorothiazide (12.5 mg) and dihydropyridine calcium antagonist were added if needed to achieve goal BP. Evaluable pts (n=930, C:388;M:542) were defined as having valid paired ACR at screening and month 5 (M5). At screening, ACR was normal in 78% (C) and 80% (M) of pts; MAU was present in 20% (C) and 18% (M); ∼3% per group had macroalbuminuria. Carvedilol reduced ACR (%change; 95%CI; p-value): -14.0%; -22.3%, -5.0%, 0.003 in all pts; metoprolol had no effect (2.5%; -6.1%, 11.9%; 0.579). The resultant percent treatment difference (C vs M) was 16.2%, 95%CI -25.3,-5.9, p=0.003. Of those pts with normalbuminuria at screening, significantly fewer pts progressed to MAU on carvedilol [6.6% (C) vs 11.1% (M)], and the odds of progressing to MAU were 47% smaller for subjects receiving carvedilol compared to those receiving metoprolol (odds ratio 0.53, 95% CI 0.30–0.93, p=0.03). BP at trial end was similar between groups (SBP/DBP± sd)C:131.4±12.7/ 77.6±8.6; M:131.7±13.9/76.7±8.4. Thus, in the presence of an ACE/ARB both beta blockers reduced BP adequately. However, carvedilol reduced MAU development as well as lowered existing ACR compared to metoprolol.
