TRENDY
Background/Rationale: Endothelial dysfunction, an early step in the pathogenesis of atherosclerotic disease, is known to precede albuminuria and predict cardiovascular prognosis. It occurs before overt kidney disease and cardiovascular disease in patients with type 2 diabetes.
Objective:
- TRENDY is the first study to analyse the NO (nitric oxide) activity in the renal circulation in type 2 diabetes patients and to directly compare the effects of Pritor®/Kinzalmono® (telmisartan) and ramipril on renal endothelial function in hypertensive patients with type 2 diabetes and normal to low grade albuminuria.
- The TRENDY study is the first head-to-head comparison of the effect of an ARB versus an ACE inhibitor on endothelial dysfunction.
Study Design: The TRENDY study was a 9-week randomised, multicenter, prospective, double-blind study in 96 hypertensive patients with type 2 diabetes, glomerular filtration rate > 80 ml/min and normo- or microalbuminuria.
Study Endpoints:
- Primary endpoint: renal plasma flow in response to L-NMMA (N-Monomethyl-L-arginine) infusion.
- Secondary endpoint: The secondary objective was to compare these two treatment arms with respect to their effect on basal NO activity (effects on RPF GFR and MAP).
Results:
- Pritor®/Kinzalmono® improved renal endothelial function similarly to ramipril.
- In addition, only Pritor®/Kinzalmono® significantly improved basal renal plasma flow and decreased vascular resistance at rest (i.e. without stimulation by infusion of l-NMMA) whereas ramipril did not significantly change these parameters.
- Both Pritor®/Kinzalmono® and ramipril reduced albuminuria in patients with microalbuminuria.
Schmieder RE et al. - Diabetes Care 2007; 30:1351–6.
Conclusion:
- In hypertensive patients with type 2 diabetes and normal to low grade albuminuria, Pritor®/Kinzalmono® significantly increased the NO activity in the renal endothelium and may therefore not only prevent the progression to overt renal disease, but also reverse it.
- These findings provide Pritor®/Kinzalmono® with data that may support the preservation of cardiovascular and renal function.
