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See also:
All diabetes clinical trials
All hypertension clinical trials
All clinical trials of anti hypertensive agent
All clinical trials of losartan
|
|
Treatments
Studied treatment |
losartan 50 to 100 mg once daily
|
Control treatment |
placebo
|
Concomittant treatment |
in addition to conventional antihypertensive treatment
(calcium-channel antagonists, diuretics, alpha-blockers,
beta-blockers, and centrally acting agents) |
Patients
Patients |
patients with type 2 diabetes and nephropathy |
Inclusion criteria |
age between 31 to 70 years; ratio of urinary albumin (measured in milligrams per liter) to urinary creatinine (measured in grams per liter) from a first morning specimen of at least 300 (or a rate of urinary protein excretion of at least 0.5 g per day) and serum creatinine values between 1.3 and 3.0 mg per deciliter (115 and 265 �mol per liter), with a lower limit of 1.5 mg per deciliter (133 �mol per liter) for male patients weighing more than 60 kg |
Exclusion criteria |
type 1 diabetes or nondiabetic renal disease; myocardial infarction; coronary- artery bypass grafting within the previous month; cerebrovascular accident; percutaneous transluminal coronary angioplasty within the previous six months; transient ischemic attack within the previous year; history of heart failure |
Baseline characteristics |
Glycosylated hemoglobin |
8.5% |
BP (systolic/diastolic) |
152/82 |
Female (%) |
36.8% |
Age |
60 y |
subgroup |
no |
hypertension (%) |
93% |
|
Method and design
Randomized effectives |
751 / 762 (studied vs. control) |
Design |
Parallel groups |
Blinding |
double-blind |
Follow-up duration |
3.4 y |
Number of centre |
250 |
Geographic area |
America, Europe, Asia |
Hypothesis |
Superiority |
Primary endpoint |
doubling of the creatinine, end-stage renal disease, death |
Results
Endpoints and data reported in the trial's publication(s)
Endpoint |
Events (%) |
Relative Risk |
95% CI |
|
Studied treat. |
Control treat. |
doubling of the serum creatinine concentration, end-stage renal disease, death |
327 / 751 (43,5%) |
359 / 762 (47,1%) |
0,92 |
[0,83;1,03] |
|
Doubling of serum creatinine concentration |
162 / 751 (21,6%) |
198 / 762 (26,0%) |
0,83 |
[0,69;1,00] |
|
End-stage renal disease |
147 / 751 (19,6%) |
194 / 762 (25,5%) |
0,77 |
[0,64;0,93] |
|
Death |
158 / 751 (21,0%) |
155 / 762 (20,3%) |
1,03 |
[0,85;1,26] |
|
End-stage renal disease or death |
255 / 751 (34,0%) |
300 / 762 (39,4%) |
0,86 |
[0,75;0,99] |
|
Doubling of serum creatinine concentration and end-stage renal disease |
226 / 751 (30,1%) |
263 / 762 (34,5%) |
0,87 |
[0,75;1,01] |
|
Endpoints used by the meta-analysis and data retained for this trial
Endpoint
Studied treat. n/N
Control treat. n/N
Graph
RR [95% CI]
renal death
327 / 751
359 / 762
0,92 [0,83;1,03]
All cause death
NA / 1513
NA / 762
1,02 [0,80;1,30]
microvascular events
NA / 1513
NA / 762
0,79 [0,66;0,95]
0
2
1.0
Relative risks
|
Endpoint |
Events (%) |
Relative Risk |
95% CI |
Endpoint definition in the trial |
Ref |
Studied treat. |
Control treat. |
renal death
|
327 / 751 (43,5%) |
359 / 762 (47,1%) |
0,92 |
[0,83;1,03] |
doubling of the serum creatinine concentration, end-stage renal disease, death |
|
The primary endpoint (if exists) appears in blod characters
|
Reference(s) used for data extraction:
|
Endpoint |
studied treat. |
control treat. |
mean diff |
Absolute risk reduction
|
Endpoint |
Events rate |
Absolute risk reduction (ARR) |
Studied treat. |
Control treat. |
renal death |
43,54% |
47,11% |
-35,7‰
|
Meta-analysis of all similar trials:
angiotensin renin system blockade in diabetes for all type of patients
angiotensin-receptor blockers in diabetes for all type of patients
anti hypertensive agent in hypertension for diabetic patients
Reference(s)
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Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, Remuzzi G, Snapinn SM, Zhang Z, Shahinfar S.
Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy..
N Engl J Med 2001;345:861-9
Pubmed
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Hubmed
| Fulltext
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