1. Olmesartan for the Delay or Prevention of Microalbuminuria in Type 2 Diabetes Hermann Haller, M.D., Sadayoshi Ito, M.D., Ph.D., Joseph L. Izzo.Jr., M.D., Andrzej Januszewicz, M.D., Shigehiro Katayama, M.D., Ph.D., Jan Menne, M.D., Albert Mimran, M.D., Ton J. Rabelink, M.D., Ph.D., Eberhard Ritz, M.D., Luis M. Ruliope, M.D., Lars C. Rump, M.D., and Giancarlo Viberti, M.D., for the ROADMAP Trial Investigators N Engl J Med 2011;364:907-917 R1 Lee, Tae-In / Prof. Woo, Jeong-Taek Journal conference

2.  Diabetic nephropathy  a common cause of ESRD USRDS: Am J kidney Dis 2003;42:Suppl 5:1-230  The renal deterioration  the patient’s blood pressure Am J kidney Dis 2000;36;646-61  Micro-albuminuria  a prediction of diabetic nephropathy and cardiovascular disease Scand J Clin Lab Invest 1971;28;183-93 Lancet 1982;1;1430-2 J Am Soc Nephrol 2006;17;2100-5 Background

3.  RAAS over-activity  the renal function in patients with diabetic nephropathy, chronic kidney disease (stage 3,4) N Eng J Med 2001;345;861-9 N Eng J Med 2001;345;851-60  ACEi or ARBs slow the worsening of renal function N Eng J Med 2004;351;1941-51

4. Method Study population and organizatioin

5. Figure S.1: Overview of disposition of patients

6.  The primary end point The time to the first onset of microalbuminuria (morning spot urine samples)  The secondary end point Cardiovascular complications and death from cardiovascular causes Method End points

7. Method Study patients

8. Results BP control 80% 71% Target BP ≤ 130/80mmHg Figure S.2: Mean sitting SBP and DBP(upper) and rate of pt reaching BP goal (lower)

9. Results Primary end point Figure 1 : Occurance of microalbuminuria during the 48 month in the two groups

10. Figure 2 : Event rate of the primary end point in the two groups according to subgroups

11. Results Secondary end point (cardiovascular end points)

13. Results Adverse events

14. delays  Olmesartan delays the time  the onset of microalbuminuria in patients with type 2 DM careful  Be careful of using ARBs to control BP  with underlying cardiovascular disease Conclusions