Antiproteinuric Effect of Imidapril Versus Ramipril in Type 2 Diabetic and Hypertensive Patients With Microalbuminuria

Study Overview
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Brief Summary
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Numerous clinical and experimental data show that the elective treatment of diabetic nephropathy should be based on drugs that inhibit the renin-angiotensin system (RAS). Albuminuria is a marker of risk not only renal but also cardiovascular and diabetic patients with concomitant non-diabetic nephropathy, on the other hand, drugs blocking the renin-angiotensin system available so far, namely ACE inhibitors and angiotensin antagonists II have proven effective in reducing proteinuria in power even if different therapeutic drug to drug. ACE inhibitors are one of the most known and used treatment options for blocking the renin-angiotensin system in patients with microalbuminuria. Drugs such as enalapril, lisinopril and ramipril are standard therapy in diabetic patients with micro or macroalbuminuria. However, it is still unclear whether their efficacy is, from this point of view, the same or varies from drug to drug. This is particularly true in the diabetic microalbuminuria, a condition in which there is sufficient documentation to prove that ramipril is effective. The main objective of this study was to assess the magnitude and trend of the time and to the antiproteinuric effect of antihypertensive 10-20mg/die imidapril versus ramipril 5-10 mg / day in hypertensive patients with type 2 diabetes and microalbuminuria.

Official Title
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Randomized, Controlled, PROBE Trial, Evaluating the Antiproteinuric Effect of Imidapril Versus Ramipril in Type 2 Diabetic Patients and Mild to Moderate Hypertension With Microalbuminuria

Conditions
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Hypertension, Type 2 Diabetes Mellitus, Microalbuminuria

Intervention / Treatment
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* Drug: Ramipril
* Drug: Imidapril


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Blood pressure> 130/80 ≤ 170/100 mmHg at the end of the period of wash-out Type 2 diabetes mellitus well controlled by medication and / or compliance with diet (HbA1c <7%) Microalbuminuria in the upper range of normal (> 150 <300 mg/24 h) Exclusion Criteria: Pregnancy, lactation or women of childbearing age. Inability to stop treatment in place for a few days during the wash-out. Sitting diastolic blood pressure> 100 mmHg or systolic pressure> 170 at the end of the wash-out. History of hypertensive encephalopathy or cerebrovascular accident within 12 months prior. Secondary hypertension. Heart failure Acute myocardial infarction; angina pectoris Liver and kidney dysfunction Known hypersensitivity to ACE inhibitors All other physiological or pathological condition that the physician may affect the evaluation of the parameters under study or interfere with the proper conduct of the study.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Imidapril<br>10 and 20 mg/day, pill | Drug: Imidapril<br>* pill, 10 and 20 mg/day, od, 24 weeks<br>|
| Active Comparator: Ramipril<br>5 and 10 mg/day, pill | Drug: Ramipril<br>* pill, 5 and 10 mg/day, od, 24 weeks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Size of the reduction of urinary albumin in 24 hours to the various controls |  | After 12 weeks from the beginning | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 1. Size of the reduction of mean 24-hour average daytime and nighttime average. 2. Size of the reduction of central blood pressure. 3. Magnitude of changes in plasma concentrations of angiotensin II, bradykinin and BNP after 24 weeks of treatment. |  | After 12 weeks from the beginning | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Imidapril, Ramipril, Hypertension, Type 2 diabetes mellitus, Microalbuminuria