Comparative Effects of Losartan and Perindopril on Uric Acid Levels in Type 2 Diabetes Mellitus Patients

Objective: This study aimed to compare the effects of losartan, an angiotensin II receptor antagonist, and Perindopril, an ACE inhibitor, on uric acid levels in type 2 Diabetes Mellitus (T2DM) patients with normoalbuminuria and microalbuminuria. Material and Methods: A total of 100 patients with T2DM were included, with 50 receiving losartan (50 mg/day) and 50 receiving perindopril (4 mg/day) for 12 weeks. Patients were stratified based on their albumin excretion levels. Baseline assessments included serum uric acid levels, blood pressure, fasting glucose, and albuminuria, with follow-up measurements conducted every four weeks. The primary endpoint was the change in serum uric acid levels, while secondary outcomes included blood pressure control and albuminuria progression. Results: Both groups exhibited comparable baseline characteristics, including serum uric acid levels, blood pressure, and fasting glucose (p > 0.05). The mean baseline uric acid level was 6.5 ± 1.1 mg/dL. After 12 weeks, uric acid levels significantly declined in the losartan group to 5.8 ± 0.9 mg/dL (mean reduction: 0.7 mg/dL, p < 0.001). In contrast, the perindopril group showed a modest, non-significant reduction to 6.2 ± 1.0 mg/dL (mean reduction: 0.2 mg/dL, p = 0.08). The reduction in uric acid was significantly greater with losartan than with perindopril (p < 0.01). No significant differences were observed between the groups in terms of blood pressure reduction (SBP, p = 0.45; DBP, p = 0.38). Among microalbuminuric patients, albumin excretion significantly decreased in both groups, from 45.2 ± 10.5 mg/24h to 30.1 ± 8.7 mg/24h (p < 0.01) in the losartan group and from 46.5 ± 11.0 mg/24h to 34.3 ± 9.4 mg/24h (p < 0.05) in the perindopril group. However, the difference in albuminuria reduction between treatments was not statistically significant (p = 0.12). Conclusion: Losartan demonstrated a greater capacity to lower uric acid levels compared to perindopril, without compromising blood pressure control or albuminuria management. Given its potential dual benefit in managing hypertension and hyperuricemia, losartan may be a preferable option for T2DM patients at risk of uric acid-related complications.