Irbesartan prevents the progression of kidney disease or death in patients with Type 2 diabetes and high blood pressure

The high blood pressure drug irbesartan (Avapro®) can protect against kidney disease in people who have high blood pressure and Type 2 diabetes, preventing the progression of kidney disease or death by 20 percent (p=0.02) versus placebo, and 23 percent (p=0.006) versus amlodipine, according to a study reported by Dr. Edmund J. Lewis, director of nephrology at Rush-Presbyterian-St. Luke’s Medical Center, Chicago. Dr. Lewis is the lead investigator of the Irbesartan Diabetic Nephropathy Trial (IDNT).

The IDNT findings were presented today, May 19, at the American Society of Hypertension (ASH) meeting in San Francisco.

“The drug is not only an excellent blood pressure drug for patients with diabetes and hypertension, but more importantly it protects their kidneys from damage independent of its effect on blood pressure,” said Dr. Lewis. “For physicians, we now have a drug that slows the progression of kidney disease, and delays or prevents the need for dialysis or transplantation.”

Kidney disease is a major problem for people whose health is already affected by high blood pressure and diabetes, according to researchers.

The researchers studied 1,715 men and women between the ages of 30 and 70 years with high blood pressure and Type 2 diabetes in an international multi-center, double-blind placebo controlled study comparing the angiotensin II blocker irbesartan, the calcium channel blocker amlodipine and a placebo group given antihypertensive medication to control the blood pressure.

Irbesartan was shown to reduce the risk of halving kidney function or progressing to transplantation or dialysis by 30 percent compared to placebo. Irbesartan was also shown to slow the progression to end-stage renal disease (ESRD) by 37 percent over amlodipine. Serum creatinine – a marker of kidney disease  rose significantly more slowly in those taking irbesartan over placebo.

Throughout the study, proteinuria (excessive amounts of protein in the urine, another sign of advanced kidney disease) was significantly reduced in the irbesartan group but not in the amlodipine or placebo groups.

Irbesartan is a member of a class of blood pressure lowering medications known as angiotensin II receptor blockers (ARBs). Drugs that block the renal angiotensin system have previously been shown to be effective in slowing the progression of both kidney and cardiovascular disease in Type 1 diabetic patients with high blood pressure.

“Since irbesartan can prevent or delay the progression of kidney disease, dialysis or kidney transplantation, treating patients with this therapy can save lives and improve quality of life,” said Lewis. “It can also lead to an enormous reduction in health care costs.”

Diabetes develops when the body cannot effectively control the level of sugar (glucose) in the blood. Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Type 2 diabetes affects approximately 200 million people worldwide.

Forty to fifty percent of patients with Type 2 diabetes will develop kidney disease, according to researchers. Kidney disease from diabetes is the most common cause of chronic renal failure leading to dialysis or transplantation.

“It is important to test all people with diabetes for any evidence of kidney disease, and based on this study, these patients should be placed on irbesartan as their kidney medicine,” said Lewis.

The study was supported by a grant from Bristol-Myers Squibb and Sanofi-Synthelabo.

Rush-Presbyterian-St. Luke’s Medical Center includes the 824-bed Presbyterian-St. Luke’s Hospital; 110-bed Johnston R. Bowman Health Center for the Elderly; Rush University (Rush Medical College, College of Nursing, College of Health Sciences and Graduate College); and seven Rush Institutes providing diagnosis, treatment and research into leading health problems. The medical center is the tertiary hub of the Rush System for Health, a comprehensive healthcare system capable of serving about two million people through its outpatient facilities and five member hospitals.