ACE Inhibitors as a Shield Against Diabetic Nephropathy

Materson, Barry J.

doi:10.1001/archinte.1996.00440030017002

Cited by 7 publications

(2 citation statements)

References 10 publications

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“…A recently completed, large, long‐term study in microalbuminuric Type 2 diabetic patients by Ravid and colleagues[36, 37] showed that treatment with an ACE inhibitor prevented deterioration in renal function over 5 years of double‐blind follow‐up, while in placebo‐treated patients renal function declined. The results have focused attention on the use of ACE inhibitors in Type 2 DM and on microalbuminuria as a point of pharmacological intervention in diabetic patients at risk of nephropathy[38]. However, the patients in this study were relatively young (mean age 44 years) and lean (body mass index 24–25 kg/m 2 ) and may not be representative of the obese, and intensely insulin‐resistant, Type 2 diabetic patient commonly encountered in general practice.…”

Section: Renal Benefits Of Blood Pressure Lowering In Type 2 Dmmentioning

confidence: 99%

Blood pressure control, microalbuminuria and cardiovascular risk in Type 2 diabetes mellitus

Marshall¹

1999

Diabetic Medicine

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Type 2 (noninsulin-dependent) diabetes mellitus (DM) affects about 3% of the UK population. Diabetes often coexists with a cluster of other potent cardiovascular risk factors, including hypertension, dyslipidaemia and increased tendency for thrombosis, and increases the risk of early death from cardiovascular causes by about threefold. Microalbuminuria or proteinuria also may be present, further increasing the risk of cardiovascular mortality. Cardiovascular risk factors must be treated aggressively in patients with Type 2 diabetes and control of blood pressure at 140/85 mm Hg or lower is a priority. The management of hypertension in patients from some ethnic groups demands special consideration because they have a high incidence of diabetes and hypertensive complications. Patients must be urged to adopt appropriate lifestyle changes in the first instance but additional drug treatment for hypertension is usually required. All the major classes of antihypertensive agents lower blood pressure in Type 2 diabetic patients but have different effects on metabolic risk factors in different ways. Low-dose thiazide diuretics, beta-blockers, calcium channel blockers and angiotensin converting enzyme (ACE) inhibitors have been shown to reduce cardiovascular risk. Individually, the effects of low-dose thiazide diuretics and beta-blockers on glucose and lipid metabolism is clinically insignificant, though in combination much larger metabolic effects are seen. ACE inhibitors and calcium channel blockers have no, or small, beneficial effects on glucose and lipid metabolism, while the greater beneficial effects of alpha1-blockers on lipid profiles may render them especially useful in the Type 2 diabetic patient. Long-acting calcium-channel blockers and ACE inhibitors protect renal function and are suitable as first line therapy in patients with microalbuminuria or proteinuria. Until results from the current batch of randomized, placebo-controlled trials comparing different classes of antihypertensive agents are available, the choice of antihypertensive agent is difficult. Addressing overall cardiovascular risk factors, rather than hypertension alone, is essential in the management of the hypertensive Type 2 diabetic patient.

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Section: Renal Benefits Of Blood Pressure Lowering In Type 2 Dmmentioning

confidence: 99%

Blood pressure control, microalbuminuria and cardiovascular risk in Type 2 diabetes mellitus

Marshall¹

1999

Diabetic Medicine

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“…In recent years, there has been a heightened awareness of the importance of kidney disease in diabetic patients. This has led to the increased use of angiotensin‐converting enzyme (ACE) inhibitors because of their well‐documented efficacy in the prevention of progressive diabetic nephropathy 1 . It is interesting to note, however, that only 15% of patients with type 1 diabetes develop nephropathy after 15 years duration of diabetes, 2 and only 5% of the diabetic population (types 1 and 2) die from nephropathy 3 .…”

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META‐ANALYSIS OF STUDIES USING SELECTIVE α₁‐BLOCKERS IN PATIENTS WITH HYPERTENSION AND TYPE 2 DIABETES

Glanz

Garber

Mancia

et al. 2001

Int J Clinical Practice

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SUMMARYThis meta‐analysis of published studies evaluated the effect of selective α1‐blockers on lipid and carbohydrate profiles and blood pressure (BP) as well as tolerability in patients with hypertension and type 2 diabetes. Publications identified via MEDLINE were used. Text and bibliographies of retrieved articles were examined for additional references. Clinical trials with a randomised comparative structure (placebo and active treatment arms) and controlled studies with other structures were included. Of the 27 citations identified, 22 studies were selected for inclusion, and five were rejected. Efficacy and safety data, lipid and carbohydrate profiles, and study and patient characteristics were extracted by two investigators independently. The mean pooled results showed beneficial effects of selective α1‐blockers on total serum cholesterol (TC), high‐density lipoprotein (HDL) cholesterol, and systolic and diastolic BP. The results also showed doxazosin had beneficial effects on fasting glucose levels, insulin sensitivity, TC, HDL cholesterol, low‐density lipoprotein (LDL) cholesterol, HDL/TC ratio, and systolic and diastolic BP. The risk difference was equivalent between the α1‐blocker group and the control group for postural hypotension or syncope. This meta‐analysis demonstrates a number of favourable effects of therapy with selective α1‐blockers in hypertensive patients with type 2 diabetes. These agents provide an effective modality for reducing BR with favourable effects on lipid, no deterioration in glycaemic control, and little risk of orthostatic hypotension.

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Current Clinical Pathophysiologic Considerations in Essential Hypertension

Fröhlich

1997

Medical Clinics of North America

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ACE Inhibitors as a Shield Against Diabetic Nephropathy

Cited by 7 publications

References 10 publications

Blood pressure control, microalbuminuria and cardiovascular risk in Type 2 diabetes mellitus

Blood pressure control, microalbuminuria and cardiovascular risk in Type 2 diabetes mellitus

META‐ANALYSIS OF STUDIES USING SELECTIVE α₁‐BLOCKERS IN PATIENTS WITH HYPERTENSION AND TYPE 2 DIABETES

Current Clinical Pathophysiologic Considerations in Essential Hypertension

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ACE Inhibitors as a Shield Against Diabetic Nephropathy

Cited by 7 publications

References 10 publications

Blood pressure control, microalbuminuria and cardiovascular risk in Type 2 diabetes mellitus

Blood pressure control, microalbuminuria and cardiovascular risk in Type 2 diabetes mellitus

META‐ANALYSIS OF STUDIES USING SELECTIVE α1‐BLOCKERS IN PATIENTS WITH HYPERTENSION AND TYPE 2 DIABETES

Current Clinical Pathophysiologic Considerations in Essential Hypertension

Contact Info

Product

Resources

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META‐ANALYSIS OF STUDIES USING SELECTIVE α₁‐BLOCKERS IN PATIENTS WITH HYPERTENSION AND TYPE 2 DIABETES