High-Dose ARBs May Benefit Diabetics

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High doses of valsartan reduce albuminuria to a greater extent than the conventional 160 mg dose in type 2 diabetics, researchers concluded.

 

Norman K. Hollenberg, MD, of Brigham and Women's Hospital in Boston, and his collaborators randomly assigned 391 hypertension patients with type 2 diabetes and albuminuria to receive treatment with 160, 320, or 640 mg doses of valsartan, an angiotensin receptor blocker (ARB).

For the first four weeks, all patients received valsartan 160 mg/day. For the subsequent 26 weeks, one group continued to receive 160 mg/day (130 patients, mean age 57.3 years) whereas the other groups received either 320 (130 patients, mean age 58.1 years) or 640 mg/day (131 patients, mean age 57.5 years). The investigators used overnight urine collections at baseline, four, 16, and 30 weeks to evaluate albuminuria.

 

At week 4, all groups had comparable reductions in albuminuria. Subsequently, the 360 and 640 mg groups experienced highly significant declines in albuminuria compared with a modest additional change in the 160 mg group, Dr. Hollenberg's group reported in the Journal of Hypertension (2007;25:1921-1926).

 

At week 30, twice as many patients returned to normal albuminuria with valsartan 640 mg compared with 160 mg (24% vs. 12%). All doses decreased BP significantly, and these declines were well sustained during the study. The effect of high-dose valsartan was independent of BP.

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