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Angiotensin‐converting enzyme inhibition by quinapril blocks the albuminuric effect of atrial natriuretic peptide in Type 1 diabetes and microalbuminuria
Author(s) -
McKenna K.,
Smith D.,
Barrett P.,
Glenn A.,
Kesson C. M.,
Connell J.,
Thompson C. J.
Publication year - 2000
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1046/j.1464-5491.2000.00255.x
Subject(s) - quinapril , microalbuminuria , medicine , endocrinology , placebo , atrial natriuretic peptide , angiotensin converting enzyme , ace inhibitor , natriuretic peptide , blood pressure , diabetes mellitus , lisinopril , heart failure , alternative medicine , pathology
Summary Aims This study examined the effect of angiotensin‐converting enzyme inhibition, administered at doses with no effect on systemic blood pressure, on the albuminuric action of atrial natriuretic peptide (ANP). Methods Seven Type 1 diabetic patients with established microalbuminuria participated in a two limb, single‐blind, placebo controlled study. Subjects were administered quinapril 10 mg daily or placebo for 7 days prior to study. On the study day, subjects were euglycaemic clamped and subsequently fluid loaded (20 ml/kg tap water orally plus urinary losses). At steady state diuresis, a 1 h intravenous infusion of ANP 0.05 μg.kg −1. min −1 was administered. Urine was collected at 15‐min intervals for estimation of albumin–creatinine ratio (ACR). Results were analysed by anova . Results Baseline mean arterial pressure was similar after pre‐treatment with quinapril and placebo (98.7 ± 3.8 vs. 100 ± 4.5 mmHg, mean ± sd , P > 0.5), and was unaltered by ANP infusion on either study day. Baseline ACR was similar on quinapril and placebo ( P = 0.13). ANP infusion induced a rise in urine ACR with placebo (58.4 ± 40.2 to 393.6 ± 262.9 mg/mmol, P = 0.006), but not with quinapril (29.3 ± 10.7 to 81.5 ± 43 mg/mmol, P = 0.15). The urine ACR response to ANP infusion was higher with placebo than with quinapril ( P = 0.02). Conclusions Quinapril blocks the albuminuric effect of intravenous infusion of ANP in subjects with Type 1 diabetes mellitus and established microalbuminuria. This action is independent of changes in mean arterial pressure and creatinine clearance.