Diabetic Nephropathy Clinical Trial
Official title:
Randomized Study of Antihypertensives and Antilipemics in American Indians With Non-Insulin-Dependent Diabetes Mellitus at High Risk of Developing Nephropathy and Cardiovascular Disease
OBJECTIVES:
I. Establish a long-term working relationship between clinical investigators and the
Minnesota American Indian community.
II. Compare the effectiveness of lisinopril (an angiotensin-converting enzyme inhibitor) and
nifedipine (a calcium channel blocker) in preventing nephropathy and vascular disease in
Minnesota American Indians with non-insulin-dependent diabetes mellitus and microalbuminuria.
III. Compare the effectiveness of simvastatin (a 3-hydroxy-3-methylglutaryl coenzyme A
reductase inhibitor) with lipid-lowering strategies recommended by the National Cholesterol
Education Program in preventing nephropathy and vascular diseases in these patients.
PROTOCOL OUTLINE:
Patients are randomly assigned to 1 of 4 treatment groups; therapy continues for 3 years. All
patients receive instruction on diet, exercise, and smoking cessation.
The first group receives daily nifedipine at a dose adjusted for high blood pressure.
Cholestyramine or gemfibrozil is administered per National Cholesterol Education Program
guidelines. Diuretics and doxazosin may be given concurrently.
The second group receives daily lisinopril at a dose adjusted for high blood pressure.
Cholestyramine or gemfibrozil is administered per National Cholesterol Education Program
guidelines. Diuretics and doxazosin may be given concurrently.
The third group receives daily nifedipine at a dose adjusted for high blood pressure, and
simvastatin at a dose adjusted for high low-density lipoproteins. Supplemental cholestyramine
may be given as needed. If cholestyramine is not tolerated or if triglycerides are high,
gemfibrozil is substituted for cholestyramine.
The fourth group receives lisinopril at a dose adjusted for high blood pressure and
simvastatin at a dose adjusted for high low-density lipoproteins.
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