Effect of angiotensin-converting-enzyme (ACE) inhibitor trandolapril on human diabetic neuropathy: Randomised double-blind controlled trial

Rayaz A. Malik, Sheila Williamson, Caroline Abbott, Anne L. Carrington, Jawaid Iqbal, Wolfgang Schady, Andrew J M Boulton

Research output: Contribution to journalArticle

204 Citations (Scopus)

Abstract

Background. Diabetes is a common cause of polyneuropathy. The development and progression of nephropathy, retinopathy, and neuropathy are closely related. Angiotensin-converting enzyme (ACE) inhibitors delay progression of both nephropathy and retinopathy. We investigated the effect of ACE inhibition on diabetic neuropathy. Methods. We recruited 41 normotensive patients with type I or type II diabetes and mild neuropathy into a randomised double-blind placebo-controlled trial. Changes in the neuropathy symptom and deficit scores, vibration-perception threshold, peripheral-nerve electrophysiology, and cardiovascular autonomic function, were assessed at 6 and 12 months. The primary endpoint was the change in peroneal nerve motor conduction velocity. Findings. We found no significant difference at baseline for age, HbA(1c), blood pressure, or severity of neuropathy between two groups. There was no change in HbA(1c) over the treatment period. Peroneal motor nerve conduction velocity (p = 0.03) and M-wave amplitude (p = 0.03) increased, and the F-wave latency (p = 0.03) decreased and sural nerve action potential amplitude increased (p = 0.04) significantly after 12 months of treatment with trandolapril compared with placebo. Vibration-perception threshold, autonomic function, and the neuropathy symptom and deficit score showed no improvement in either group. Interpretation. The ACE inhibitor trandolapril may improve peripheral neuropathy in normotensive patients with diabetes. Larger clinical trials are needed to confirm these data before changes to clinical practice can be advocated.

Original languageEnglish
Pages (from-to)1978-1981
Number of pages4
JournalLancet
Volume352
Issue number9145
DOIs
Publication statusPublished - 26 Dec 1998
Externally publishedYes

Fingerprint

trandolapril
Peroneal Nerve
Diabetic Neuropathies
Neural Conduction
Vibration
Angiotensin-Converting Enzyme Inhibitors
Placebos
Sural Nerve
Polyneuropathies
Electrophysiology
Peripheral Nervous System Diseases
Peptidyl-Dipeptidase A
Peripheral Nerves
Type 2 Diabetes Mellitus
Action Potentials
Clinical Trials
Blood Pressure
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Effect of angiotensin-converting-enzyme (ACE) inhibitor trandolapril on human diabetic neuropathy : Randomised double-blind controlled trial. / Malik, Rayaz A.; Williamson, Sheila; Abbott, Caroline; Carrington, Anne L.; Iqbal, Jawaid; Schady, Wolfgang; Boulton, Andrew J M.

In: Lancet, Vol. 352, No. 9145, 26.12.1998, p. 1978-1981.

Research output: Contribution to journalArticle

Malik, Rayaz A. ; Williamson, Sheila ; Abbott, Caroline ; Carrington, Anne L. ; Iqbal, Jawaid ; Schady, Wolfgang ; Boulton, Andrew J M. / Effect of angiotensin-converting-enzyme (ACE) inhibitor trandolapril on human diabetic neuropathy : Randomised double-blind controlled trial. In: Lancet. 1998 ; Vol. 352, No. 9145. pp. 1978-1981.
@article{c3b95a545bb141218dc0e2ef2721ce7d,
title = "Effect of angiotensin-converting-enzyme (ACE) inhibitor trandolapril on human diabetic neuropathy: Randomised double-blind controlled trial",
abstract = "Background. Diabetes is a common cause of polyneuropathy. The development and progression of nephropathy, retinopathy, and neuropathy are closely related. Angiotensin-converting enzyme (ACE) inhibitors delay progression of both nephropathy and retinopathy. We investigated the effect of ACE inhibition on diabetic neuropathy. Methods. We recruited 41 normotensive patients with type I or type II diabetes and mild neuropathy into a randomised double-blind placebo-controlled trial. Changes in the neuropathy symptom and deficit scores, vibration-perception threshold, peripheral-nerve electrophysiology, and cardiovascular autonomic function, were assessed at 6 and 12 months. The primary endpoint was the change in peroneal nerve motor conduction velocity. Findings. We found no significant difference at baseline for age, HbA(1c), blood pressure, or severity of neuropathy between two groups. There was no change in HbA(1c) over the treatment period. Peroneal motor nerve conduction velocity (p = 0.03) and M-wave amplitude (p = 0.03) increased, and the F-wave latency (p = 0.03) decreased and sural nerve action potential amplitude increased (p = 0.04) significantly after 12 months of treatment with trandolapril compared with placebo. Vibration-perception threshold, autonomic function, and the neuropathy symptom and deficit score showed no improvement in either group. Interpretation. The ACE inhibitor trandolapril may improve peripheral neuropathy in normotensive patients with diabetes. Larger clinical trials are needed to confirm these data before changes to clinical practice can be advocated.",
author = "Malik, {Rayaz A.} and Sheila Williamson and Caroline Abbott and Carrington, {Anne L.} and Jawaid Iqbal and Wolfgang Schady and Boulton, {Andrew J M}",
year = "1998",
month = "12",
day = "26",
doi = "10.1016/S0140-6736(98)02478-7",
language = "English",
volume = "352",
pages = "1978--1981",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier Limited",
number = "9145",

}

TY - JOUR

T1 - Effect of angiotensin-converting-enzyme (ACE) inhibitor trandolapril on human diabetic neuropathy

T2 - Randomised double-blind controlled trial

AU - Malik, Rayaz A.

AU - Williamson, Sheila

AU - Abbott, Caroline

AU - Carrington, Anne L.

AU - Iqbal, Jawaid

AU - Schady, Wolfgang

AU - Boulton, Andrew J M

PY - 1998/12/26

Y1 - 1998/12/26

N2 - Background. Diabetes is a common cause of polyneuropathy. The development and progression of nephropathy, retinopathy, and neuropathy are closely related. Angiotensin-converting enzyme (ACE) inhibitors delay progression of both nephropathy and retinopathy. We investigated the effect of ACE inhibition on diabetic neuropathy. Methods. We recruited 41 normotensive patients with type I or type II diabetes and mild neuropathy into a randomised double-blind placebo-controlled trial. Changes in the neuropathy symptom and deficit scores, vibration-perception threshold, peripheral-nerve electrophysiology, and cardiovascular autonomic function, were assessed at 6 and 12 months. The primary endpoint was the change in peroneal nerve motor conduction velocity. Findings. We found no significant difference at baseline for age, HbA(1c), blood pressure, or severity of neuropathy between two groups. There was no change in HbA(1c) over the treatment period. Peroneal motor nerve conduction velocity (p = 0.03) and M-wave amplitude (p = 0.03) increased, and the F-wave latency (p = 0.03) decreased and sural nerve action potential amplitude increased (p = 0.04) significantly after 12 months of treatment with trandolapril compared with placebo. Vibration-perception threshold, autonomic function, and the neuropathy symptom and deficit score showed no improvement in either group. Interpretation. The ACE inhibitor trandolapril may improve peripheral neuropathy in normotensive patients with diabetes. Larger clinical trials are needed to confirm these data before changes to clinical practice can be advocated.

AB - Background. Diabetes is a common cause of polyneuropathy. The development and progression of nephropathy, retinopathy, and neuropathy are closely related. Angiotensin-converting enzyme (ACE) inhibitors delay progression of both nephropathy and retinopathy. We investigated the effect of ACE inhibition on diabetic neuropathy. Methods. We recruited 41 normotensive patients with type I or type II diabetes and mild neuropathy into a randomised double-blind placebo-controlled trial. Changes in the neuropathy symptom and deficit scores, vibration-perception threshold, peripheral-nerve electrophysiology, and cardiovascular autonomic function, were assessed at 6 and 12 months. The primary endpoint was the change in peroneal nerve motor conduction velocity. Findings. We found no significant difference at baseline for age, HbA(1c), blood pressure, or severity of neuropathy between two groups. There was no change in HbA(1c) over the treatment period. Peroneal motor nerve conduction velocity (p = 0.03) and M-wave amplitude (p = 0.03) increased, and the F-wave latency (p = 0.03) decreased and sural nerve action potential amplitude increased (p = 0.04) significantly after 12 months of treatment with trandolapril compared with placebo. Vibration-perception threshold, autonomic function, and the neuropathy symptom and deficit score showed no improvement in either group. Interpretation. The ACE inhibitor trandolapril may improve peripheral neuropathy in normotensive patients with diabetes. Larger clinical trials are needed to confirm these data before changes to clinical practice can be advocated.

UR - http://www.scopus.com/inward/record.url?scp=0032570130&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032570130&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(98)02478-7

DO - 10.1016/S0140-6736(98)02478-7

M3 - Article

C2 - 9872248

AN - SCOPUS:0032570130

VL - 352

SP - 1978

EP - 1981

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 9145

ER -