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"Effects of losartan on renal and
cardiovascular outcomes in patients with type 2 diabetes and
nephropathy," by Barry M. Brenner and 9 others, for the RENAAL Study
Investigators, New England
Journal of Medicine, 345(12): 861-9, 20 September 2001.
[Authors' affiliations: 8 institutions
worldwide]
Abstract: "Background Diabetic nephropathy is the leading
cause of end-stage renal disease. Interruption of the
renin-angiotensin system slows the progression of renal disease in patients
with type 1 diabetes, but similar data are not available for patients with
type 2, the most common form of diabetes. We assessed the role of the
angiotensin-II receptor antagonist losartan in patients with type 2 diabetes
and nephropathy. Methods A total of 1513 patients were enrolled in this
randomized, double-blind study comparing losartan (50 to 100 mg once daily)
with placebo, both taken in addition to conventional antihypertensive
treatment (calcium-channel antagonists, diuretics, alpha-blockers,
beta-blockers, and centrally acting agents), for a mean of 3.4 years. The
primary outcome was the composite of a doubling of the base-line serum
creatinine concentration, end-stage renal disease, or death. Secondary end
points included a composite of morbidity and mortality from cardiovascular
causes, proteinuria, and the rate of progression of renal disease. Results
A total of 327 patients in the losartan group reached the primary end point,
as compared with 359 in the placebo group (risk reduction, 16 percent;
P=0.02). Losartan reduced the incidence of a doubling of the serum creatinine
concentration (risk reduction, 25
percent; P=0.006) and end-stage renal disease (risk reduction, 28 percent;
P=0.002) but had no effect on the rate of death. The benefit exceeded that
attributable to changes in blood pressure. The composite of morbidity and
mortality from cardiovascular causes was similar in the two groups, although
the rate of first hospitalization for heart failure was significantly lower
with losartan (risk reduction, 32 percent; P=0.005). The level of proteinuria
declined by 35 percent with losartan (P<0.001 for the comparison with
placebo). Conclusions Losartan conferred significant renal benefits in
patients with type 2 diabetes and nephropathy, and it was generally well
tolerated."
This 2001 report from the New England
Journal of Medicine was cited 57 times in current journal
articles
indexed by Thomson ISI during March-April 2003. Only two other medicine papers
published in the last two
years, excluding reviews, managed to tally a greater number of citations
during that two-month period. Prior to
the most recent bimonthly count, citations to the paper have accrued as
follows:
January-February 2003: 51 citations
November-December 2002: 63
September-October 2002: 43
July-August 2002: 31
May-June 2002: 24
March-April 2002: 20
January-February 2002: 14
November-December 2001: 10
September-October 2001: 3
Total citations to date: 316
SOURCE: Hot
Papers Database (Included with a subscription to the ISI print newsletter Science
Watch®, available from the ISI
Research Services Group. Packaged on a CD-ROM that is mailed with each Science
Watch issue, the Hot
Papers Database contains data on hundreds of highly cited papers published
during the last two years. User interface permits searching by author,
organization, journal, field, and more. Total citations, as well as citations
accrued during successive bimonthly periods, can be assessed and graphed. An
updated CD containing the most recent bimonthly data is mailed with every new
issue of Science
Watch,
six times a year. The CD also includes an electronic version of the Science
Watch
issue in HTML format, for personal desktop access.)
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