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389 AFRICAN AMERICAN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND PERSISTENT MICROALBUMINURIA DESPITE ANGIOTENSIN-CONVERTING ENZYME INHIBITOR THERAPY HAVE WORSE ENDOTHELIAL DYSFUNCTION COMPARED TO THOSE WHOSE MICROALBUMINURIA HAS RESPONDED TO THERAPY
  1. A. A. Jawa,
  2. V. A. Fonseca
  1. New Orleans, LA.

Abstract

Type 2 diabetic patients with persistent microalbuminuria (MA) despite angiotensin-converting enzyme inhibitor therapy (ACEI) carry a poorer prognosis independent of glycemic, hypertension and lipid control. Furthermore, African American (AA) patients are reported to respond less well to ACEI than Caucasians, putting them at increased risk for disease progression. We evaluated clinical features and endothelial function in AA patients on ACEI with persistent microalbuminuria (MA; n = 20; 8 M: 12 F) and those whose microalbuminuria had responded completely to therapy (no MA; n = 7; 3 M: 4 F). There was no statistically significant difference in both groups (MA vs. no MA) in terms of mean age (53 vs. 53.4), HbA1c (9.47 ± 0.30 vs. 9.82 ± 0.88), systolic BP (146 ± 3.7 vs. 139 ± 3.8), diastolic BP (85 ± 2.1 vs. 81 ± 3.8), LDL (111.9 ± 14.3 vs.92.5 ± 9.2), HDL (38.9 ± 2.1 vs. 40 ± 3.6) and triglycerides (113.9 ± 22 vs. 101.6 ± 19). Endothelial function was assessed by brachial artery diameter response to occlusion measured by ultrasound (flow mediated dilation; FMD) and nonendothelial dependent dilation using sublingual nitroglycerine (NDD). Resting brachial artery diameters were 0.40 ± 0.028 cm in MA and 0.35 ± 0.024 cm in no MA groups; the difference was not statistically significant. The mean FMD ± SEM was 4.59 ± 1.97% in MA and 11.43 ± 1.66% in no MA group (p = .004). The mean percentage increase in NDD ± SEM was 14.1 ± 2.5% in MA and 14.18 ± 2.6% in no MA (p = .98). We conclude that AA patients who have persistent MA despite ACEI therapy have impaired endothelial function as compared to those whose microalbuminuria was eliminated by ACEI with comparable blood pressure control. This finding may explain the poor prognosis of these patients in terms of progression of nephropathy and cardiovascular events.

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