Renal Protective Effects of Combination of Diltiazem and ACEI/ARB on the Progression of Diabetic Nephropathy: Randomized Controlled Trial
Krairittichai, U.; Sarinnapakorn, V.; Mahannopkul, R.; Ainwan, P.
Journal of the Medical Association of Thailand 100(Suppl 1): S40-S47
2017
ISSN/ISBN: 0125-2208 PMID: 29927180 Document Number: 17501
Strict control of blood sugar and maintenance of normal blood pressure levels are the standard treatments shown to delay the progression of diabetic nephropathy in type 2 diabetic patients. The recommended antihypertensive medications for diabetic nephropathy are angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB). Previous studies have shown that a non-dihydropyridine calcium channel blocker (diltiazem) could reduce urinary protein excretion in type 2 diabetic patients. To evaluate the effects of the combinations of diltiazem and ACEI/ARB treatment compared with ACEI/ARB alone in type 2 diabetic patients with diabetic nephropathy. A prospective, randomized, double-blind, placebo-controlled multicenter trial was conducted at the 39 cases in the diltiazem group (78.0%) and 38 in the placebo group (67.9%) completed the 1-year treatment. The diltiazem group achieved better preservation of glomerular filtration rate and had lower proteinuria than the placebo group (p<0.05), whereas blood pressure was similar in the two groups. Four patients in the diltiazem group and one patient in the placebo group developed severe pedal edema and discontinue treatment. A combination of diltiazem and ACE/ARB could reduce proteinuria and preserve kidney function in type 2 diabetic patients with diabetic nephropathy.