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Previous Volume 351:1941-1951 November 4, 2004 Number 19 Next

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ABSTRACT

Background The multicenter double-blind, randomized Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) was designed to assess whether angiotensin-converting–enzyme inhibitors and non-dihydropyridine calcium-channel blockers, alone or in combination, prevent microalbuminuria in subjects with hypertension, type 2 diabetes mellitus, and normal urinary albumin excretion.

Methods We studied 1204 subjects, who were randomly assigned to receive at least three years of treatment with trandolapril (at a dose of 2 mg per day) plus verapamil (sustained-release formulation, 180 mg per day), trandolapril alone (2 mg per day), verapamil alone (sustained-release formulation, 240 mg per day), or placebo. The target blood pressure was 120/80 mm Hg. The primary end point was the development of persistent microalbuminuria (overnight albumin excretion, 20 µg per minute at two consecutive visits).

Results The primary outcome was reached in 5.7 percent of the subjects receiving trandolapril plus verapamil, 6.0 percent of the subjects receiving trandolapril, 11.9 percent of the subjects receiving verapamil, and 10.0 percent of control subjects receiving placebo. The estimated acceleration factor (which quantifies the effect of one treatment relative to another in accelerating or slowing disease progression) adjusted for predefined baseline characteristics was 0.39 for the comparison between verapamil plus trandolapril and placebo (P=0.01), 0.47 for the comparison between trandolapril and placebo (P=0.01), and 0.83 for the comparison between verapamil and placebo (P=0.54). Trandolapril plus verapamil and trandolapril alone delayed the onset of microalbuminuria by factors of 2.6 and 2.1, respectively. Serious adverse events were similar in all treatment groups.

Conclusions In subjects with type 2 diabetes and hypertension but with normoalbuminuria, the use of trandolapril plus verapamil and trandolapril alone decreased the incidence of microalbuminuria to a similar extent. The effect of verapamil alone was similar to that of placebo.

Source Information

From the Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo (P.R., A.F., A.P.I., S.B., I.P.I., V.B., N.R., G.G., F.A., M.G., B.E.-I., F.G., A.P., G.R.); the Unit of Nephrology, Azienda Ospedaliera, Ospedali Riuniti, Bergamo (P.R., G.R.); the Unit of Diabetology of the Treviglio Hospital, Treviglio (A.B.); and the Unit of Diabetology of the Bergamo Hospital, Bergamo (R.T., A.R.D.) — all in Italy.

Address reprint requests to Dr. Ruggenenti at the Mario Negri Institute for Pharmacological Research, Via Gavazzeni, 11, 24125 Bergamo, Italy, or at manuelap{at}marionegri.it.

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Preventing Microalbuminuria in Type 2 Diabetes
Zandi-Nejad K., Brenner B. M., Mauer M., Fioretto P., Ruggenenti P., Perna A., Remuzzi G.
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N Engl J Med 2005; 352:833-834, Feb 24, 2005. Correspondence

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