Comparative efficacy and safety of ace inhibitors and arbs in prevention and progression of diabetic nephropathy

Introduction: DN is one of the major complication of Diabetes Mellitus (DM), with high morbidity and mortality as well as major cause of end stage renal disease (ESRD). Early detection of DN and intervention in pre-clinical state can slow down disease progression thereby improving overall survival in patients with DN.
Aims & Objectives: To compare the efficacy and safety of ACE inhibitors and ARBs in prevention and progression of diabetic nephropathy (DN).
Materials & Methods: An interventional, analytical study being conducted in the department of Pharmacology, HIMS, Dehradun over a period of 12 months. 72 Patients fulfilling the inclusion criteria were recruited in the study by computer generated random number tables & specific baseline investigations like Serum Cystatin C & urinary albumin were done. Drug Ramipril 2.5-5 mg or Telmisartan 20-40mg on physician discretion was prescribed once daily for a period of 3 months after which specific investigations were repeated.
Results : The average Pre and Post-therapy Serum Cystatin C levels for ACE Is and ARBs were 0.95±0.29 mg/dl, 0.73±0.23 mg/dl and 0.91±0.25 mg/dl, 0.73±0.26 mg/dl and urinary albumin levels were 154.37±74.27 mg/dl, 145.99±72.72 mg/dl and 150.60±58.63 mg/dl, 134.89±54.94 mg/dl respectively. Conclusion: ACE Is and ARBs were both found to be equally efficacious and safe. Post therapy Serum Cystatin C significantly declined suggestive of improved renal function in DN patients.