Reducing proteinuria with an ARBTelmisartan (Micardis), a novel angiotensin receptor blocker (ARB), and the older ARB losartan (Cozaar) are both effective in hypertensive patients with diabetic nephropathy, but telmisartan better reduces proteinuria, a research group told the American Society of Hypertension meeting in Chicago.

“At similar levels of BP control, telmisartan may confer greater protection against progression to end-stage renal disease,” said George Bakris, MD, director of the hypertension center at the University of Chicago Hospitals.Using renin-angiotensin system blockade to control BP is essential for decreasing renal disease progression in diabetes, Dr. Bakris observed. Studies have shown that a proteinuria reduction >30% slows progression of diabetic nephropathy and decreases cardiovascular events.

The investigators randomized 860 patients to 50 weeks of either telmisartan 80 mg or losartan 100 mg. The mean final urinary protein/creatinine ratio after one year declined 29% in the telmisartan group and 20% in the losartan group. BP reductions were comparable in the two groups. The statistically significant differences in proteniuria effect could relate to pharmacologic factors, such as lipophilicity, magnitude of receptor binding, and duration of action, Dr. Bakris speculated.

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