Change in Albuminuria Is Predictive of Cardiovascular Outcome in Normotensive Patients With Type 2 Diabetes and Microalbuminuria

Abstract

Microalbuminuria is associated with cardiovascular complications and all-cause mortality in patients with diabetes (1–3). Inhibitors of the renin-angiotensin system (RAS) protect renal and cardiac function in these patients, at least partly independent of the associated blood pressure reduction (4–9). Recently, a few studies showed that reduction in albuminuria in hypertensive diabetic patients reduces the risk of subsequent cardiovascular events (10–12). The question remains whether this risk reduction is explained by the reduction of high blood pressure. No data are available for normotensive diabetic patients. Therefore, we investigated whether sustained change in albuminuria independently predicts cardiovascular outcome in patients with type 2 diabetes and microalbuminuria but without hypertension. The present study is a prospective follow-up study of 67 normotensive patients (baseline blood pressure ≤140/90 mmHg without antihypertensive treatment) with type 2 diabetes and microalbuminuria (urinary albumin excretion 20–200 mg/l), who participated in a previously published, larger, randomized, double-blind, placebo-controlled, multicenter trial investigating the short-term effects of the angiotensin-receptor antagonist losartan on microalbuminuria (7). Exclusion criteria included a history of macrovascular complications and a baseline serum creatinine level >150 μmol/l. After the original 20-week study period, a cohort of 67 patients from that study was prospectively followed during mean ± SEM 4.7 ± 0.1 years. They were recruited on the basis of their address and received standard medical care. Data were collected on current and past health, medication use, blood pressure, renal function, and albuminuria, which was annually assessed …