A COMPARATIVE STUDY OF EFFECTIVENESS OF ENALAPRIL, LOSARTAN AND THEIR COMBINATION IN REDUCTION OF PROTEINURIA AMONG PATIENTS OF TYPE 2 DIABETIC NEPHROPATHY

Abstract

Background

Proteinuria is a hallmark of DN (Diabetic Nephropathy), and its reduction is crucial for renal protection. ACE (Angiotensin-Converting Enzyme) inhibitors and ARBs (Angiotensin Receptor Blockers) are known to lower proteinuria and slow DN progression. However, limited data exist comparing the effectiveness and tolerability of enalapril and losartan individually and in combination in achieving anti-proteinuric effects.

Methods

This interventional study enrolled 62 newly diagnosed patients with type 2 diabetic nephropathy attending the outpatient nephrology department at Government Medical College, Kottayam. Patients were randomly assigned to receive either enalapril (n=30) or losartan (n=32), with dose titration every 2 months up to the maximum dose until achieving a 50% reduction in 24-hour urine protein (enalapril 40 mg, losartan 100 mg). Patients not achieving target proteinuria reduction were switched to combination therapy. Adverse events, including hyperkalemia, rise in creatinine, and cough, were monitored. Statistical analysis was done using SPSS version 16.

Results

Both the enalapril and losartan groups achieved a significant reduction in proteinuria during the study. At the first follow-up, Enalapril showed a greater reduction (73.3%) compared to Losartan (31.2%, p = 0.001). However, by the end of the study, 86.7% of Enalapril and 84.4% of Losartan patients achieved the target, showing no statistically significant difference (p = 0.798). Combination therapy was required in two patients (one from each group). Adverse effects were minimal and comparable, with hyperkalaemia occurring in 6.2% of losartan-treated patients and cough in 3.3% of enalapril-treated patients.

Conclusion

Enalapril and losartan are equally effective in reducing proteinuria in type 2 diabetic nephropathy with similar adverse event profiles. Either drug may be considered for initial anti-proteinuria therapy, or combination treatment may be reserved for resistant cases. Further studies with larger populations and extended follow-up are recommended to validate these findings.