Based on the results of four major renal outcome studies (Micro-HOPE
, IRMA-2, RENAAL, IDNT studies), the American diabetes association has recommended ARBs for treatment of overt diabetic nephropathy, whereas patients with only microalbuminuria are recommended to be treated with either ACE inhibitors or ARBs10,11.
Na mesma epoca, os resultados do classico estudo MICRO-HOPE (24) reforcaram essa evidencia, utilizando um diferente IECA, o ramipril, demonstrando capacidade de prevenir a evolucao de micro para macroalbuminuria no DM2, com reducao da nefropatia manifesta em 24%; p = 0,027.
Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: result of the HOPE study and Micro-HOPE Substudy.
Previously unpublished results of MICRO-HOPE (Microalbuminuria, Cardiovascular, and Renal Outcomes in the Heart Outcomes Prevention Evaluation), a prospective substudy within the landmark HOPE study, failed to show any benefit for 400 IU of vitamin E per day over placebo for the prevention of microvascular complications in 3,654 randomized patients with diabetes mellitus.
Vitamin E also failed to have any impact on cardiovascular events in diabetic participants in MICRO-HOPE or in nondiabetic subjects with cardiovascular disease who were randomized to receive vitamin E in the larger HOPE trial.
Vitamin E was studied in HOPE and MICRO-HOPE because results of the Physicians' Health Study, the Nurses' Health Study, and other observational studies suggested that ingesting more than 100 IU of vitamin E per day reduces the risk of cardiovascular disease.
, a subset of the HOPE trial, studied ramipril (Altace) 10 mg/d vs placebo in 2437 patients with diabetes who did not have clinical proteinuria.
Those patients with diabetes who do not have clinical evidence of CVD have a similar mortality rate from CVD as patients who do not have diabetes but do have known CVD. The Heart Outcomes Prevention Evaluation (HOPE) study and the MICRO-HOPE
substudy added a low dose of ramipril to the current regimen in patients with diabetes who are older than 55 years and have additional risk factors, which lowered the risk of death, cardiovascular events, and nephropathy by 24% to 25% each.