Effect of Valsartan on Blood Pressure and Urinary Albumin Excretion in Hypertensive Type 2 Diabetic Patients: An Open-Label, Multicenter Study

Se Jun Park; Dae Jung Kim; Hae Jin Kim; Soo Yeon Park; Ji A Seo; Nan Hee Kim; Sung Hee Choi; Soo Lim; Hak Chul Jang; Seung Hyun Ko; Ki Ho Song; Yu Bae Ahn; Soo Kyoung Kim; Yong Wook Cho; Jun Goo Kang; Sung Hee Ihm; Cheol Young Park; Sung Woo Park; Dong Hyun Shin; Yong Hyun Kim; Kwan Woo Lee

doi:10.4093/kdj.2008.32.6.513

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Park, Kim, Kim, Park, Seo, Kim, Choi, Lim, Jang, Ko, Song, Ahn, Kim, Cho, Kang, Ihm, Park, Park, Shin, Kim, and Lee: Effect of Valsartan on Blood Pressure and Urinary Albumin Excretion in Hypertensive Type 2 Diabetic Patients: An Open-Label, Multicenter Study

Original Article

Korean Diabetes Journal

Korean Diabetes Journal 2008; 32(6): 513-521.

Published online: 31 December 2008

DOI: https://doi.org/10.4093/kdj.2008.32.6.513

Effect of Valsartan on Blood Pressure and Urinary Albumin Excretion in Hypertensive Type 2 Diabetic Patients: An Open-Label, Multicenter Study

Se Jun Park, Dae Jung Kim, Hae Jin Kim, Soo Yeon Park¹, Ji A Seo¹, Nan Hee Kim¹, Sung Hee Choi², Soo Lim², Hak Chul Jang², Seung Hyun Ko³, Ki Ho Song³, Yu Bae Ahn³, Soo Kyoung Kim⁴, Yong Wook Cho⁴, Jun Goo Kang⁵, Sung Hee Ihm⁵, Cheol Young Park⁶, Sung Woo Park⁶, Dong Hyun Shin⁷, Yong Hyun Kim⁷, Kwan Woo Lee

Department of Endocrinology and Metabolism, Ajou University School of Medicine, Korea.

¹Department of Internal Medicine, Korea University College of Medicine, Korea.

²Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea.

³Department of Internal Medicine, Catholic University College of Medicine, Korea.

⁴Department of Internal Medicine, Pochon CHA University, Korea.

⁵Department of Internal Medicine, Hallym University College of Medicine, Korea.

⁶Department of Internal Medicine, Sungkyunkwan University School of Medicine, Korea.

⁷Department of Internal Medicine, Bundang Jesaeng General Hospital, Korea.

Corresponding author: jinkim@ajou.ac.kr

Received 22 September 2008 Accepted 10 October 2008

Abstract

Background

Activation of renin-angiotensin system (RAS) has been an important mechanism of microvascular and macrovascular complications in diabetic patients. It has been reported that RAS blockades reduce the development and progression of diabetic nephropathy. The aim of this study was to evaluate whether valsartan, an angiotensin II receptor blocker (ARB), reduced blood pressure and urinary albumin excretion rate (UAER) in hypertensive type 2 diabetic patients.

Method

Three hundred forty-seven hypertensive type 2 diabetic patients who had not taken angiotensin converting enzyme inhibitors or ARB for 6 months prior to this study were enrolled. We measured blood pressure and UAER before and after 24 weeks of valsartan treatment.

Result

Baseline mean systolic and diastolic blood pressure was 143 ± 15 and 87 ± 11 mmHg, respectively and the median albumin excretion rate was 27 ug/mg. Reduction in systolic and diastolic blood pressure was 16 mmHg/10 mmHg and the median UAER was 19.3 ug/mg after 24 weeks (P < 0.01, respectively). When we divided the subjects into three groups according to the UAER (normoalbuminuria, microalbuminuria and macroalbuminuria), significant changes were reported in the microalbuminuria and the macroalbuminuria groups. Thirty-eight (42%) patients with microalbuminuria improved to normoalbuminuria and twelve (41%) patients with macroalbuminuria improved to microalbuminuria. We found an association between the improvement of blood pressure and UAER (R = 0.165, P = 0.015).

Conclusion

We concluded that valsartan reduces urinary albumin excretion and blood pressure in hypertensive type 2 diabetic patients.

Keywords: Angiotensin, Blood pressure, Diabetes mellitus, Valsartan

Figures and Tables

Fig. 1

Changes in the urinary albumin excretion rate in each albuminuria group. It was noted that the urinary albumin excretion rate reduced in each group after valsartan (or valsartan/chlorthiazide) administration. The values were reported as median. UAER, urine albumin excretion ratio. ^*P < 0.05, compared to the initial value.

Fig. 2

Changes of the albuminuria status in each albuminuria group after 24 weeks of valsartan administration. Thirty-eight (43%) patients with microalbuminuria improved to normoalbuminuria and twelve (41%) patients with macroalbuminuria improved to microalbuminuria.

Fig. 3

Correlation between the reduction of systolic blood pressure and urinary albumin excretion rate. Blood pressure reduction was associated with a decreased urinary albumin excretion ratio (R = 0.165, P = 0.015). △SBP, reduction of systolic blood pressure; △UAER, reduction of urinary albumin excretion ratio.

Table 1

Baseline characteristics

Values are reported as means ± standard deviation. HbA1c, Glycosylated hemoglobin; HDL, high density lipoprotein; LDL, low density lipoprotein. ^*P < 0.05, compared to initial value.

Table 2

Changes from baseline after 24 weeks valsartan (or valsartan/chlorthiazide) administration

SBP and DBP are reported as mean ± standard deviation and UAER is reported as median. DBP, diastolic blood pressure; SBP, systolic blood pressure; UAER, urine albumin excretion ratio. ^*P < 0.05, compared to initial value.

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