Comparison of Telmisartan and Verapamil in Reducing Proteinuria in Diabetic Nephropathy Patients

Abstract

Background: In diabetes, complications often extend to diabetic nephropathy, marked by proteinuria. This study investigates telmisartan and verapamil's efficacy in mitigating proteinuria. Verapamil, a calcium channel blocker, dilates vessels, while telmisartan, an angiotensin II receptor blocker, induces vasodilation. However, evidence is confined to a single foreign study, prompting this research for more comprehensive insights. Objective: To comparison of telmisartan and verapamil in reducing proteinuria in diabetic nephropathy patients. Study Design: It was a prospective comparative study. Settings: Department of Medicine, DHQ Teaching Hospital, KMU Institute of Medical Sciences, Kohat. Duration: 05-02-2022 to 05-08-2022. Methods: One hundred patients with diabetic retinopathy and meeting inclusion criteria were enrolled in the study after taking informed written consents and two equal groups were made using lottery method. Patients in group A were given trandolapril 2 mg/day + telmisartan 80 mg/day whereas patients in group B were given trandolapril 2 mg/day + verapamil 120 mg/day, for three months. Study variables were noted at baseline and at three months. SPSS version 26.0 was used for data analysis. Results: Mean age of the patients was 46.20±13.80 years. Gender distribution revealed that 52.0% were male, while 48.0% were female. The duration of the disease varied among the participants, with an overall mean of 9.20±3.73 years. Mean BMI was 27.46±3.50 kg/m². MABP was recorded as 120.16±2.84 mmHg. Proteinuria, a significant parameter in this study, was observed with a mean value of 354.37±20.26 g/day. Glomerular Filtration Rate (GFR) was measured at 56.72±2.52 mL/dk. HbA1C was found to be 8.94±0.34%. Both the groups did not possess any significant difference between them at baseline (p-value>0.05). After treatment, mean proteinuria level in this study was significantly less in group A than group B with p-value=0.043. Moreover, mean change in proteinuria between before and after treatment was significantly high in group A than group B (p-value=0.000). After treatment mean GFR was less in insignificantly high in group A than group B (p-value=0.450) and likewise mean change in GFR from the baseline also had insignificant difference between the groups (p-value=0.489). Post treatment, mean HbA1c and MABP were less in group A than group B but the difference was not significant (p-value>0.05). Likewise, mean change also had insignificant difference between the groups. Conclusion: In conclusion, our study comparing the effects of Trandolapril with Telmisartan versus Trandolapril with Verapamil in diabetic nephropathy patients revealed a significant reduction in proteinuria in the Telmisartan group. However, no substantial differences were noted in GFR, HbA1c, and MABP between the groups. These findings provide valuable insights into optimal therapeutic strategies for managing diabetic nephropathy.