Background: Rilmenidine is an innovative antihypertensive agent that binds specifically to I1 imidazoline receptors. The antihypertensive efficacy of rilmenidine in treating type-2 diabetics has been demonstrated, and is associated with very good clinical and laboratory tolerance.
Design: This was a 6-month, double-blind, randomized, controlled study comparing the effects of rilmenidine and captopril on the progression of microalbuminuria in a population of patients with mild-to-moderate hypertension [90 mmHg < diastolic blood pressure (DBP) < 110 mmHg], type-2 diabetes, and microalbuminuria (30 mg/24 h < urine albumin excretion < or = 300 mg/24 h).
Results: Between month 0 and month 6, the mean supine blood pressure was reduced in a similar manner by rilmenidine (systolic blood pressure from 159 to 141 mmHg and diastolic blood pressure from 98 to 84 mmHg) and captopril (systolic blood pressure from 157 to 144 mmHg and diastolic blood pressure from 101 to 82 mmHg). The median value for microalbuminuria was reduced from 160 (90-260) to 56 (27-87) mg per 24 h by rilmenidine and from 144 (51-200) to 54 (41-123) mg per 24 h by captopril. Rate of clearance of creatinine was not significantly changed during the study by either treatment (with rilmenidine it varied from 95.2 to 95.6 ml/min; with captopril it varied from 86.2 to 90.4 ml/min). There was no statistical difference between the changes in levels of glycosylated hemoglobin for the groups treated with rilmenidine and captopril. Clinical and laboratory acceptabilities were good, and those for the two groups were comparable.
Conclusion: Rilmenidine exerts similar antihypertensive effects to those of captopril on the hypertensive with type-2 diabetes. Decreases in microalbuminuria elicited by the two treatments do not differ. That administration of rilmenidine decreases microalbuminuria suggests that it could exert nephroprotective effects.