Effects of angiotensin-converting enzyme inhibitor (alacepril) and calcium antagonist (nicardipine) in hypertensive non-insulin-dependent diabetic patients with microalbuminuria

The influence of alacepril (50 mg/day) on arterial blood pressure and microproteinuria in 26 hypertensive non-insulin-dependent diabetic patients was studied for 16 weeks. Alacepril reduced blood pressure gradually from $\text{175}\text{88}$ (standard error of mean [SEM] $\text{2.6}\text{1.7}$) to $\text{152}\text{81}$ ($\text{3.3}\text{2.0}$) mm Hg (P < .005) and albuminuria from 160.6 (SEM 29.1) to 98.1 (14.1) mg/g Cr (P < .05), while serum blood urea nitrogen, creatinine, HbA_1c, and fructosamine (FRA) remained stable. No significant changes occurred in the urinary β₂ microglobulin and N-acetyl-β-d-glucosaminidase levels. As compared with the effects of a calcium antagonist (nicardipine, 60 mg/day) that reduced blood pressure from $\text{170}\text{92}$ (SEM $\text{2.5}\text{1.4}$) to $\text{154}\text{84}$ ($\text{2.5}\text{1.5}$) mm Hg (P < .001) and albuminuria from 162.2 (SEM 33.9) to 95.4 (25.0) mg/g Cr (not significant), it is suggested that the angiotensin-converting enzyme inhibitor (alacepril) may have an advantageous renal effect in spite of its mild antihypertensive effect.