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Effects of ACE Inhibition and Angiotensin II Receptor Blockade on Glomerular Basement Membrane Protein Excretion and Charge Selectivity in Type 2 Diabetic Patients

Section of Endocrinology and Metabolism Department of Internal Medicine, Marmara University, Istanbul, Turkey, odeyneli{at}marmara.edu.tr

Dilek Yavuz

Section of Endocrinology and Metabolism Department of Internal Medicine, Marmara University, Istanbul, Turkey

Ayliz Velioglu

Department of Biochemistry, Marmara University, Istanbul, Turkey

Hasan Cacma

Department of Biochemistry, Marmara University, Istanbul, Turkey

Nihal Aksoy

Department of Biochemistry, Marmara University, Istanbul, Turkey

Goncagül Haklar

Department of Biochemistry, Marmara University, Istanbul, Turkey

Yavuz Taga

Department of Biochemistry, Marmara University, Istanbul, Turkey

Sema Akalm

Section of Endocrinology and Metabolism Department of Internal Medicine, Marmara University, Istanbul, Turkey

Angiotensin-converting enzyme (ACE) inhibitors may reduce urinary albumin excretion (UAE) by decreasing glomerular pressure and increasing glomerular charge selectivity through preservation of glycosaminoglycans. The effect of Angiotensin II antagonism on glomerular charge selectivity remains to be determined. The aim of this study was to compare the effects of an AT₁ blocker losartan and an ACE inhibitor (ACE-I) enalapril on UAE, extracellular matrix proteins, glycosaminoglycan excretion (U_GAG) and red blood cell anionic charge (RBCCh) which are the indirect markers of glomerular basement membrane anionic content in hypertensive Type 2 diabetic patients. Twenty-four patients were randomised into two groups and received either enalapril (5—20 mg/d) or losartan (50—100 mg/d). All parameters were measured at baseline and after six months of treatment. At the end of six months, systolic and diastolic blood pressures (BP), UAE rates, U_GAG excretion and RBCCh were significantly and equally reduced in both treatment groups compared with baseline. RBCCh was negatively correlated with UAE (r=-0. O 57, p<0.0001) and U_GAG excretion (r=-0.57, Rp<0.0001); UAE was correlated with U_GAG excretion (r=0.58, p<0.0001). In conclusion, enalapril and losartan treatment were equally effective in reducing BP, UAE as well as U_GAG excretion and preserving RBCCh in hypertensive Type 2 diabetic patients. ACE inhibition and AT₁-receptor blockade may have favourable effects on preserving glomerular anionic content in hypertensive diabetic patients.

Key Words: Hypertension • Type 2 Diabetes mellitus • Glomerular charge selectivity • Angiotensin-converting enzyme inhibitors • Angiotensin II receptor blockers

Journal of Renin-Angiotensin-Aldosterone System, Vol. 7, No. 2, 98-103 (2006)
DOI: 10.3317/jraas.2006.016


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