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Randomised controlled trial of long term efficacy of captopril on preservation of kidney function in normotensive patients with insulin dependent diabetes and microalbuminuria

BMJ 1999; 319 doi: (Published 03 July 1999) Cite this as: BMJ 1999;319:24
  1. Elisabeth R Mathiesen, consultant (,
  2. Eva Hommel, chief physician,
  3. Henrik P Hansen, research fellow,
  4. Ulla M Smidt, laboratory technician,
  5. Hans-Henrik Parving, professor
  1. Steno Diabetes Center, DK 2860 Gentofte, Copenhagen, Denmark
  1. Correspondence to: Dr E R Mathiesen, Medical Endocrine Department, University Hospital of Copenhagen, Rigshospitalet, 2100 Copenhagen Ø, Denmark
  • Accepted 31 December 1998

In patients with insulin dependent diabetes, angiotensin converting enzyme inhibition delays the progression from microalbuminuria to diabetic nephropathy, but previous studies have been too short to show a preservation of kidney function.13 We assessed the effectiveness of angiotensin converting enzyme inhibition on preservation of kidney function in an 8 year prospective, randomised controlled trial.

Patients, methods, and results

Forty four normotensive patients with insulin dependent (type I) diabetes and persistent microalbuminuria (30-300 mg/24 h) were enrolled as previously described in detail.1 The treatment group (n=21) was given captopril (100 mg/24 h) and bendrofluazide (2.5 mg/24 h). The 23 remaining patients were left untreated. Diabetic nephropathy was defined as albuminuria persistently >300 mg/24 h. Glomerular filtration rate was measured annually with Crom EDTA plasma clearance over 4 hours.1

After 4 years two patients in each group were excluded because they did not attend follow up sessions. Four of the patients …

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