1. לדיובן הגנה כלייתית מוכחת בחולי סכרת מסוג 2, (היפרטנסיבים ונורמוטנסיבים) עם מיקרואלבומינוריה לדיובן הגנה כלייתית מוכחת בחולי סכרת מסוג 2, (היפרטנסיבים ונורמוטנסיבים) עם מיקרואלבומינוריה חזק בהגנה כלייתית

2. MARVAL: MicroAlbuminuria Reduction With Valsartan Objective: To assess the effects on UAER (independent of BP reduction) of valsartan treatment in patients with type 2 diabetes and microalbuminuria in comparison with amlodipine treatment Methods: 332 patients 35-75 years with type 2 diabetes and microalbuminuria, with or without hypertension Valsartan 80 mg od (n=169) or amlodipine 5 mg od (n=163) for 24 weeks Target blood pressure 135/85 mm Hg Viberti et al, Circulation. 2002;106;672-678

3. Mean BP Effects in Type 2 Diabetic Patients with MicroAlbuminuria (MARVAL) -11.2 -6.6 -11.6 -6.5 SBPDBP Valsartan Amlodipine Mean  from baseline (mm Hg) at 24 weeks Viberti et al, Circulation. 2002;106;672-678

4. MARVAL: MicroAlbuminuria Reduction With Valsartan Weeks UAER % change from baselin e Amlodipine Valsartan 048121824 -60 -40 -20 0 20 P < 0.001 -8% -44% Viberti et al, Circulation. 2002;106;672-678

5. 0 5 10 15 20 25 30 35 † P=0.001 vs. amlodipine Valsartan Amlodipine MARVAL: MicroAlbuminuria Reduction With Valsartan 14.5% 29.9% † % of Patients Returning to Normoalbuminuria* Status * Defined as UAER < 20  g/min

6. MARVAL: Conclusions Significant reduction in UAER with valsartan vs. amlodipine –reductions observed in groups with / without hypertension More valsartan patients returned to normal levels of albumin in urine after 24 weeks than amlodipine patients BP reduction comparable between groups For same BP reduction, valsartan was significantly more effective in reducing UAER in type 2 diabetes patients with microalbuminuria Viberti et al, Circulation. 2002;106;672-678