Beneficial effect of lisinopril plus telmisartan in patients with type 2 diabetes, microalbuminuria and hypertension.

Author(s): Sengul AM, Altuntas Y, Kurklu A, Aydin L

Affiliation(s): Department of 2nd Internal Medicine, Division of Endocrinology and Diabetes, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.

Publication date & source: 2006-02, Diabetes Res Clin Pract., 71(2):210-219. Epub 2005 Aug 19.

Angiotensin-converting enzyme (ACE) inhibitors have favourable effects on hypertension and diabetic nephropathy, but persistent use may result in incomplete blockade of the renin-angiotensin system. Long-term effects of dual blockade using the ACE inhibitor lisinopril and the long-acting angiotensin II receptor blocker (ARB) telmisartan on blood pressure and albumin excretion rate (AER) were evaluated. Patients with type 2 diabetes mellitus, hypertension (systolic blood pressure [SBP] >/=140mmHg or diastolic blood pressure [DBP] >/=90mmHg) and microalbuminuria (AER 30-300mg/24h) received 20mg of lisinopril or 80mg of telmisartan once a day for 24 weeks. Patients were then randomised to continuing treatment with the respective monotherapy or with lisinopril plus telmisartan for a further 28 weeks. Significant (P<0.001) declines in SBP (11.1mmHg versus 10.0mmHg), DBP (5.6mmHg versus 5.3mmHg) and AER (98mg/24h versus 80mg/24h) were achieved with lisinopril (n=95) or telmisartan (n=97), respectively, after 24 weeks. Subsequent treatment with lisinopril plus telmisartan for 28 weeks resulted in further significant reductions (P<0.001) in SBP, DBP and AER compared with either monotherapy. All treatments were well tolerated. Lisinopril plus telmisartan thus provides superior blood pressure and AER control than either monotherapy. We conclude that use of dual blockade may provide a new approach to prevention of diabetic nephropathy in patients with type 2 diabetes, hypertension and microalbuminuria.