Methodology: 175 T2DM patients on regular follow-up with microalbuminuria (eUACR >30), aged <75 years, irrespective of their A1c, on standard glucose, lipid and blood pressure lowering therapy using ARB (valsartan or telmisartan) were followed-up for 2 years. 2 groups were identified, Control group (Cn) on conventional dose CDARB’s and case (Cs) group on high dose HDARB’s. Renal (creatinine, eGFR, UACR) and CV (SBP, DBP, BMI, Lipid profile, hs-CRP) parameters were evaluated in both groups at 3-6 monthly intervals. NT-ProBNP was evaluated in both groups at the end of the study. Patients with history of any revascularization, IHD or hospitalization in last 1 year, eGFR <45, hyperkalemia >5.5 were excluded. Data was analysed using PSPP version 1.0.1 and represented as Mean (Standard deviation), independent sample t-test and paired t test was used. P-value of 0.05 was considered significant.
Results: Both groups Cs and Cn were well matched for treatment and clinical characteristics except DBP, higher mean in Cs (81 ±11.39) vs. Cn (76.80 ± 11.58, p 0.025). Mean CDARB dose in Cn group (Telmisartan 55.15mg (SD ± 24) and valsartan 115.76 (SD ±47.82) vs. Cs group HDARB (telmisartan 222.22mg (SD±49.22) and valsartan 334.58 (SD±77.81). Within the cases there was a significant reduction seen in A1c, SBP, hs-CRP, lipid parameters and UACR over 2 years. Within the control group there was a significant reduction seen in A1c, lipid parameters, UACR. At the end of the follow-up there was significant reduction seen in Cs in LDL (Cs 51.34 ±19.73 vs. Cn 63.82 ± 25.97, p-0.005) and non-HDL (Cs 66.77 ±34.74 vs. Cn 51.70 ±44.56, p-0.023). There was a trend towards reduction in hs-CRP in Cs (Cs 1.74 ± 1.92 vs. Cn 2.53 ± 3.70, p-0.066). The NT-ProBNP remained high in both groups (142.86 ±232.32 vs. 192.61 ±260.93, p-0.203).
Conclusion: HDARB may be associated with better vascular protection as shown by improvements in LDL, non-HDL and hs-CRP compared to CDARB in T2DM with microalbuminuria.
V. Gupta: None. V. Teli: None.
