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ESC Congress 2004: First long-term comparative study of an ARB and an ACE inhibitor in patient with type 2 diabetes, hypertension and early nephropathy
August 31, 2004Results from the first long-term comparative study of an angiotensin receptor blocker (ARB) and an ACE inhibitor in patients with type 2 diabetes, hypertension and early nephropathy were presented today.1 The five year DETAIL (Diabetics Exposed to Telmisartan And enalaprIL) study showed that telmisartan provides comparable renoprotective effects to enalapril.
The prospective, multicentre, double-blind, double-dummy, parallel-group study involved 250 patients with type 2 diabetes, hypertension and early nephropathy.2 Patients received either once daily telmisartan 80 mg or enalapril 20 mg for five years. The primary endpoint of the study was change from baseline in glomerular filtration rate after five years. DETAIL is the first study of its kind to directly measure glomerular filtration rate (GFR) to monitor the progression of kidney disease.
The level of GFR is widely accepted as the best measure of overall kidney function in health and disease and is a major determinant of end stage renal disease (ESRD).3 The DETAIL study shows that telmisartan is comparable to enalapril in reducing GFR decline. The study supports the renoprotective benefits of the ARB
class shown in previous studies and is the first to demonstrate that an ARB offers equivalent renoprotection to an ACE inhibitor.
"DETAIL is a highly clinically relevant study - it provides the first comparative evidence on the long-term renal protective effects of an ARB vs an ACE inhibitor in patients with type 2 diabetes, hypertension and early nephropathy over five years. It is particularly significant as it demonstrates that an ARB, telmisartan, is equivalent to an ACE inhibitor, enalapril, in providing renal protection" commented lead investigator Professor Anthony Barnett, Consultant Physician, Clinical Director of Diabetes and Endocrinology, Birmingham Heartlands Hospital and Professor of Medicine, University of Birmingham, United Kingdom.
Although the DETAIL patients all had type 2 diabetes, hypertension and nephropathy, the five-year cardiovascular mortality in both treatment groups was much lower than would be expected in this high-risk group. The incidence of adverse events was similar between the two groups as ACE-inhibitor intolerant patients were excluded from the study. Blood pressure was lowered in both groups to a comparable degree over the course of the trial.
Current US and European hypertension guidelines advocate first line use of ARBs and ACE inhibitors for hypertensive patients with type 2 diabetic nephropathy.4,5 Various studies have shown that effective RAAS blockade can reduce renal damage by mechanisms which appear to be beyond those of blood pressure control alone. For ACE inhibitors, the evidence for renoprotection independent of blood pressure control derives mainly from observations in patients with type 1 diabetes.6 In type 2 diabetes, trial evidence for renoprotection is now stronger with ARBs which have proved to be more effective than other antihypertensive classes in slowing the progression of kidney disease in patients with microalbuminuria or overt proteinuria.7,8,9,10
A Barnett (Birmingham, GB)
European Society of Cardiology (ESC)
class shown in previous studies and is the first to demonstrate that an ARB offers equivalent renoprotection to an ACE inhibitor.
"DETAIL is a highly clinically relevant study - it provides the first comparative evidence on the long-term renal protective effects of an ARB vs an ACE inhibitor in patients with type 2 diabetes, hypertension and early nephropathy over five years. It is particularly significant as it demonstrates that an ARB, telmisartan, is equivalent to an ACE inhibitor, enalapril, in providing renal protection" commented lead investigator Professor Anthony Barnett, Consultant Physician, Clinical Director of Diabetes and Endocrinology, Birmingham Heartlands Hospital and Professor of Medicine, University of Birmingham, United Kingdom.
Although the DETAIL patients all had type 2 diabetes, hypertension and nephropathy, the five-year cardiovascular mortality in both treatment groups was much lower than would be expected in this high-risk group. The incidence of adverse events was similar between the two groups as ACE-inhibitor intolerant patients were excluded from the study. Blood pressure was lowered in both groups to a comparable degree over the course of the trial.
Current US and European hypertension guidelines advocate first line use of ARBs and ACE inhibitors for hypertensive patients with type 2 diabetic nephropathy.4,5 Various studies have shown that effective RAAS blockade can reduce renal damage by mechanisms which appear to be beyond those of blood pressure control alone. For ACE inhibitors, the evidence for renoprotection independent of blood pressure control derives mainly from observations in patients with type 1 diabetes.6 In type 2 diabetes, trial evidence for renoprotection is now stronger with ARBs which have proved to be more effective than other antihypertensive classes in slowing the progression of kidney disease in patients with microalbuminuria or overt proteinuria.7,8,9,10
A Barnett (Birmingham, GB)
European Society of Cardiology (ESC)
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