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RENAAL Baseline Characteristics (I). Losartan (+CT) (n=751) 60 62 39 16 17 48 19 2 152 82 30. Placebo (+CT) (n=762) 60 65 35 18 14 50 18 1 153 82 29. Age, years Male, % Female, %
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RENAAL Baseline Characteristics (I) Losartan (+CT) (n=751) 60 62 39 16 17 48 19 2 152 82 30 Placebo (+CT) (n=762) 60 65 35 18 14 50 18 1 153 82 29 Age, years Male, % Female, % Race, % Asian Black Caucasian Hispanic Other Systolic (mmHg) Diastolic (mmHg) BMI (kg/m2) % Brenner BM et al New Engl J Med 2001;345(12):861-869.
RENAAL Baseline Characteristics (II) Losartan (+CT) (n=751) % 92 9 10 0.1 0 31 9 50 66 20 Placebo (+CT) (n=762) % 95 10 12 0.1 0.1 36 9 50 62 17 Medical History Treatment for Hypertension Angina Pectoris Myocardial Infarction Coronary Revascularization Stroke Lipid Disorders Amputation Neuropathy Retinopathy Smoking (current) Brenner BM et al New Engl J Med 2001;345(12):861-869.
RENAAL Baseline Characteristics (III) Losartan (+CT) (n=751) 1237 1.9 227 142 45 213 12.5 8.5 Placebo (+CT) (n=762) 1261 1.9 229 142 45 225 12.5 8.4 Laboratory Urinary alb:creat (median) (mg/g) Serum Creatinine (mg/dL) Serum Cholesterol (mg/dL) Total LDL HDL Serum Triglycerides (mg/dL) Hemoglobin (g/dL) Glycosylated Hemoglobin (%) p=NS for all values Brenner BM et al New Engl J Med 2001;345(12):861-869.
RENAAL Primary Components ESRD 30 Risk Reduction: 28% p=0.002 P (+CT) 20 % with event L (+CT) Doubling of Serum Creatinine 10 Risk Reduction: 25% 0 30 p=0.006 0 12 24 36 48 Months P (+CT) P (+ CT) 762 715 610 347 42 20 751 714 625 375 69 L (+ CT) L (+CT) % with event 50 ESRD or Death 10 40 Risk Reduction: 20% p=0.01 P (+CT) 0 30 0 12 24 36 48 % with event L (+CT) 20 Months P (+ CT) 295 762 689 554 36 10 L (+ CT) 52 751 692 583 329 0 0 12 24 36 48 Brenner BM et al New Engl J Med2001;345(12):861-869. Months P (+ CT) 762 715 610 347 42 L (+ CT) 751 714 625 375 69
20 15 10 5 0 RENAALFirst Hospitalization for Heart Failure Risk Reduction: 32% p=0.005 P (+CT) % with event L (+CT) 0 12 24 36 48 Months P (+CT) 762 685 616 375 53 L (+CT) 751 701 637 388 74 Brenner BM et al New Engl J Med 2001;345(12):861-869.
RENAALChange from Baseline in Proteinuria 40 20 P (+CT) 0 Median Percent Change p<0.001 -20 35% Overall Reduction -40 L (+CT) -60 0 12 24 36 48 Months P (+CT) 762 632 529 390 130 130 130 130 130 130 L (+CT) 751 661 558 438 167 167 167 167 167 167 Proteinuria measured as the urine albumin:creatinine ratio from a first morning void. Brenner BM et al New Engl J Med 2001;345(12):861-869.
RENAALMost Common Clinical and Laboratory Adverse Experiences Leading to Discontinuation of Study Therapy 6% 6 (+CT) Losartan (+CT) Placebo 4 3% 3% Percentage 2% 2% 2 1.5% 1% 1% 1% 1% 1.2% 1.1% 1% 0.5% 0 Heart ESRD Myocard. Stroke Worsening sCr Hyper- Failure infarction renal increased kalemia insufficiency Laboratory AE Clinical AE Presented by Brenner B. Reduction of endpoints in non-insulin-dependent diabetes mellitus with angiotensin II antagonist losartan. Program and abstracts of the 16th Annual Meeting of the American Society of Hypertension; May 16-19, 2001; San Francisco, California
RENAAL Summary • In patients with Type 2 diabetes and nephropathy: • losartan delayed the onset of the primary composite endpoint (DsCr/ESRD/Death) and delayed the progression to ESRD. • losartan reduced proteinuria and the rate of decline in renal function (1/sCr slope). • losartan reduced the incidence of hospitalization for heart failure. • these benefits were largely independent of achieved blood pressure. • losartan and placebo, on a background of conventional therapy, showed no significant difference on all-cause mortality, MI, stroke, revascularization, hospitalizations for unstable angina, and death due to CV disease. • losartan was generally well tolerated in this patient population. Brenner BM et al New Engl J Med 2001;345(12):861-869.