Angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists for preventing the progression of diabetic kidney disease

Abstract

BackgroundAngiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor antagonists (AIIRA) are considered to be equally e ective for patients with diabetic kidney disease (DKD), but renal and not mortality outcomes have usually been considered. ObjectivesTo evaluate the benefits and harms ACEi and AIIRA in patients with DKD.

Angiotensin Converting Enzyme Insertion/Deletion Gene Polymorphism: An Observational Study among Diabetic Hypertensive Subjects in Malaysia

“…As this is a retrospective study, it is rather difficult to determine the class of antihypertensive agents that contributed most to GFR maintenance especially when GFR trend were similar in all the subgroups compared (ACEI vs ACEI+one AHT vs ACEI+two AHTs), irrespective of the class/number of antihypertensive agents used. A critical appraisal of the data suggests that there was no significant synergistic antiproteinuric effect of dihydropyridine CCBs and diuretic type of antihypertensive drugs in the present study, unlike other studies that reported beneficial renoprotective effect when other drugs such as angiotensin II receptor antagonist [17] and potassium-sparring diuretics [18] were used in combination with ACEIs. This implies that ACEI, a common denominator in all the subgroups may have been the major contributor to GFR maintenance.…”

Angiotensin Converting Enzyme Insertion/Deletion Gene Polymorphism: An Observational Study among Diabetic Hypertensive Subjects in Malaysia

“…As this is a retrospective study, it is rather difficult to determine the class of antihypertensive agents that contributed most to GFR maintenance especially when GFR trend were similar in all the subgroups compared (ACEI vs ACEI+one AHT vs ACEI+two AHTs), irrespective of the class/number of antihypertensive agents used. A critical appraisal of the data suggests that there was no significant synergistic antiproteinuric effect of dihydropyridine CCBs and diuretic type of antihypertensive drugs in the present study, unlike other studies that reported beneficial renoprotective effect when other drugs such as angiotensin II receptor antagonist [17] and potassium-sparring diuretics [18] were used in combination with ACEIs. This implies that ACEI, a common denominator in all the subgroups may have been the major contributor to GFR maintenance.…”

Optimal strategies for identifying kidney disease in diabetes: properties of screening tests, progression of renal dysfunction and impact of treatment – systematic review and modelling of progression and cost-effectiveness

“…Previous studies of microalbuminuric patients found that RAASI reduced progression of proteinuria. 82,126 We have confirmed this and, further, shown that there is benefit in both type 1 and type 2 diabetes. However, the benefit of RAASI in primary microalbuminuria prevention found in a previous review in patients with normoalbuminuria 63 was only confirmed in our review for patients with type 2 diabetes.…”

Distribution of DD Genotype of Angiotensin-Converting Enzyme Gene and Its Correlation with Diabetic Retinopathy

“…An important risk factor for the development of DR is persistently high blood pressure (hypertension) (24). Numerous studies have shown that ACE inhibitors have therapeutic benefits against diabetes complications (25)(26)(27). The results of this study showed that the frequency of the DD genotype in diabetic patients with retinopathy was higher than that in diabetic individuals without retinopathy.…”

Angiotensin Converting Enzyme Insertion/Deletion Gene Polymorphism: An Observational Study among Diabetic Hypertensive Subjects in Malaysia

“…As this is a retrospective study, it is rather difficult to determine the class of antihypertensive agents that contributed most to GFR maintenance especially when GFR trend were similar in all the subgroups compared (ACEI vs ACEI+one AHT vs ACEI+two AHTs), irrespective of the class/number of antihypertensive agents used. A critical appraisal of the data suggests that there was no significant synergistic antiproteinuric effect of dihydropyridine CCBs and diuretic type of antihypertensive drugs in the present study, unlike other studies that reported beneficial renoprotective effect when other drugs such as angiotensin II receptor antagonist [17] and potassium-sparring diuretics [18] were used in combination with ACEIs. This implies that ACEI, a common denominator in all the subgroups may have been the major contributor to GFR maintenance.…”

Optimal strategies for identifying kidney disease in diabetes: properties of screening tests, progression of renal dysfunction and impact of treatment – systematic review and modelling of progression and cost-effectiveness

“…Previous studies of microalbuminuric patients found that RAASI reduced progression of proteinuria. 82,126 We have confirmed this and, further, shown that there is benefit in both type 1 and type 2 diabetes. However, the benefit of RAASI in primary microalbuminuria prevention found in a previous review in patients with normoalbuminuria 63 was only confirmed in our review for patients with type 2 diabetes.…”

Distribution of DD Genotype of Angiotensin-Converting Enzyme Gene and Its Correlation with Diabetic Retinopathy

“…An important risk factor for the development of DR is persistently high blood pressure (hypertension) (24). Numerous studies have shown that ACE inhibitors have therapeutic benefits against diabetes complications (25)(26)(27). The results of this study showed that the frequency of the DD genotype in diabetic patients with retinopathy was higher than that in diabetic individuals without retinopathy.…”

Angiotensin Converting Enzyme Insertion/Deletion Gene Polymorphism: An Observational Study among Diabetic Hypertensive Subjects in Malaysia

“…As this is a retrospective study, it is rather difficult to determine the class of antihypertensive agents that contributed most to GFR maintenance especially when GFR trend were similar in all the subgroups compared (ACEI vs ACEI+one AHT vs ACEI+two AHTs), irrespective of the class/number of antihypertensive agents used. A critical appraisal of the data suggests that there was no significant synergistic antiproteinuric effect of dihydropyridine CCBs and diuretic type of antihypertensive drugs in the present study, unlike other studies that reported beneficial renoprotective effect when other drugs such as angiotensin II receptor antagonist [17] and potassium-sparring diuretics [18] were used in combination with ACEIs. This implies that ACEI, a common denominator in all the subgroups may have been the major contributor to GFR maintenance.…”

Optimal strategies for identifying kidney disease in diabetes: properties of screening tests, progression of renal dysfunction and impact of treatment – systematic review and modelling of progression and cost-effectiveness

“…Previous studies of microalbuminuric patients found that RAASI reduced progression of proteinuria. 82,126 We have confirmed this and, further, shown that there is benefit in both type 1 and type 2 diabetes. However, the benefit of RAASI in primary microalbuminuria prevention found in a previous review in patients with normoalbuminuria 63 was only confirmed in our review for patients with type 2 diabetes.…”

Distribution of DD Genotype of Angiotensin-Converting Enzyme Gene and Its Correlation with Diabetic Retinopathy

“…An important risk factor for the development of DR is persistently high blood pressure (hypertension) (24). Numerous studies have shown that ACE inhibitors have therapeutic benefits against diabetes complications (25)(26)(27). The results of this study showed that the frequency of the DD genotype in diabetic patients with retinopathy was higher than that in diabetic individuals without retinopathy.…”