ADDM Study - Amtrel and Co-Diovan in Type 2 Diabetes Mellitus Hypertension Patients With Microalbuminuria
ADDM Study - Amtrel and Co-Diovan in Type 2 Diabetes Mellitus Hypertension Patients With Microalbuminuria
The purpose of the study is to compare the change from baseline in blood pressures (DBP/SBP)
 to 16-week regimen between Amtrel® and Co-Diovan®. The secondary objectives were listed as
 the following.

 -  To compare the response rate (defined as SBP < 130 mmHg and DBP < 80 mmHg) at the end of
 study

 -  To evaluate the change from baseline in albumin-to-creatinine ratio with
 antihypertensive medications in whole group (combined treatment groups) and each
 treatment group (Amtrel®, Co-Diovan®) at Week 16

 -  The change from baseline in glycosylated hemoglobin (HbA1c) at Week 16

 -  The change from baseline in fasting plasma glucose (FPG) at Week 16

 -  The change from baseline in fasting lipid profiles (triglyceride, total cholesterol,
 high-density lipoprotein cholesterol, low-density lipoprotein cholesterol) at Week 16

 -  The change from baseline in arteriosclerosis marker (brachial-ankle pulse-wave velocity
 (ba-PWV) and ankle-brachial pressure index (ABI), using Colin-VP1000) at Week 16

 -  The change from baseline on the body mass index (BMI) and waist-hip ratio (WHR) at each
 specified study time point

 -  To ascertain the safety and tolerability of Amtrel® versus Co-Diovan® including AE/SAE,
 and laboratory examinations
At the screening visit, patients who fulfilled the entrance criteria and had given written
 informed consent entered a placebo running period where they discontinued antihypertensive
 medication for two weeks. During that period, Adalat 5mg could be given for emergency. At the
 end of placebo running period those patients became hypertensive (i.e., SBP between
 130-180mmHg or DBP between 80-110mmHg) were randomized into either treatment group. For those
 patients remaining normotensive continued to be on placebo run-in for another two weeks (10 -
 14 days). After the two-week (10 - 14 days) placebo run-in period those patients became
 hypertensive were randomized into either treatment group. However for those patients
 remaining normotensive were excluded from the study. After randomization into either arm,
 patients entered four months treatment period. The dosage adjustment were proceed in order to
 reach the best effect. During the treatment period there was a monthly visit to assess the
 response of the patients.

 The starting dose of Amtrel® was 1 capsule (contains 1/2 tablet) (amlodipine / benazepril
 hydrochloride 2.5 mg/ 5 mg) every morning and could be adjusted up to 2 capsules (contains 1
 tablet per capsule) (amlodipine / benazepril hydrochloride 10 mg/ 20 mg) every morning if
 patients did not achieve the criteria of SBP<130 mmHg and DBP< 80 mmHg during treatment
 period.

 The starting dose of Co-Diovan® was 1 capsule (contains 1/2 tablet) (valsartan/
 hydrochlorothiazide 40 mg/ 6.25 mg) every morning and could be adjusted up to 2 capsules
 (contains 1 tablet per capsule) (valsartan/ hydrochlorothiazide 160 mg/ 25.0 mg) every
 morning if patients did not achieve the criteria of SBP<130 mmHg and DBP< 80 mmHg during
 treatment period.

 All randomized patients attended monthly clinic visits for the 16-week treatment period. At
 week 4 (Visit 3), all patients were force-titrated to 1 capsule (1 tablet per capsule) for 4
 weeks. Subsequently, those patients did not achieve the target blood pressure (SBP<130 mmHg
 and DBP<80 mmHg) were titrated monthly to next dose level (2 capsule per day).
Inclusion Criteria:

 -  type 2 diabetes with stable controlled (HbA1c between 6.5-10%)

 -  SBP between 130-180mmHg or DBP between 80-110mmHg

 -  microalbuminuria (UAE 30-300mg/24hrs or creatinine 30-300mg/g)

 Exclusion Criteria:

 -  IDDM or secondary forms of diabetes

 -  hepatic and/or renal dysfunction

 -  serum potassium level > 5.5mmol/L

 -  severe renal disease

 -  Chronic Heart Failure (NYHA class III or IV)

 -  unstable CV disease

 -  PTCA within 3 months