Rationality of treating early diabetic nephropathy with combination of angiotensin-converting enzyme inhibition and angiotensin IItype 1 receptor antagonist

Objective To detect the rationality of treating early diabetic nephropathy with the combination of angiotensin converting enzyme inhibition(ACEI) and angiotensin Ⅱ type 1 receptor(AT 1) antagonist.Methods According to the random and prospective study,a 18 weeks long therapy has been performed in 68 patients with type 2 diabetes and early diabetic nephropathy.22 cases selected by chance were cured with Benazpril only as group 1.Another 25 cases selected by chance were cured with Irbesartan only as group 2.The rest 21 cases were cured with the combination of Benazpril and Irbesartan as group 3.Before,during and after the therary,examinations were performed to every patient to determine parameters such as the mean arterial pressure(MAP),urinary albumin excretion rate(UAER),endogenous creatinine clearance(CCr),serum creatinine(SCr),blood urea nitrogen(BUN),fasting blood glucose(FBG),2 h blood glucose(2 hBG),hemoglobin A1c(HbA 1c),blood lipid and serum potassium.Results ①Before,during and after the therary,no obvious differences were found among each group on sCr,BUN,FBG,2 hBG,HbA 1c,blood lipid and serum potassium.② After the therapy,a 7.8% descent of MAP was found(P 0.05 ),but there were no obvious differences between groups.③ The UAER descended 33.9% in group 1(t= 3.278 ,P= 0.004 ), 36.2% in group 2(t= 4.234 ,P 0.001 ),and 60.9% in group 3(t= 5.754 ,P 0.001 ).There was no obvious difference between group 1 and group 2(P 0.05 ).The descent amplitude of group 3 was 26.1% higher than that of group 1 and group 2.Conclusion It is a reasonable and safe way to treat early diabetic nephropathy with the combination of ACEI and AT 1 antagonist.