Effect of Angiotensin Blockade on the Association between Albuminuria and Peripheral Arterial Disease in Elderly Taiwanese Patients with Type 2 Diabetes Mellitus

Background The aim of the present study was to examine the impact of the clinical use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) on the association between the urinary albumin/creatinine ratio (ACR) and ankle-brachial index (ABI) or peripheral arterial disease (PAD) in elderly Taiwanese patients with type 2 diabetes mellitus. Methods and Results Two-hundred and ninety patients ( 108 men, 182 women) aged ≥65 years ( mean ± SD, 71.6 ±4.9) were cross-sectionally studied. ACR was expressed as the natural logarithm [ln( ACR)] and divided into normoalbuminuria (<30.0 μg/mg) and albuminuria (30.0 μg/mg). ABI was evaluated both continuously and as peripheral arterial disease (PAD) (-) and PAD (+) using the cutoff of 0.9. Statistical analyses were performed with consideration of covariates and the use of ACEI/ARB. Results showed that in patients not using ACEI/ARB, ln (ACR) negatively correlated with ABI (r=-0.261, p<0.01) and was associated with ABI with adjusted regression coefficient of- 0.0213 (p<0. 05). PAD patients had a significantly higher level of ln (ACR) than those without PAD (4.83±1.34 vs 3.73±1.29, p<0.001) and PAD prevalence was significantly higher in those with albuminuria than in those with normoalbuminuria (22.6% vs 4.9%, p