Angiotensin converting enzyme inhibitors versus calcium antagonists in the treatment of diabetic hypertensive patients.

Ferder, León; Daccordi, Horacio; Martello, Mauro; Panzalis, M; Inserra, Felipe

doi:10.1161/01.hyp.19.2_suppl.ii237

Cited by 61 publications

(32 citation statements)

References 26 publications

(7 reference statements)

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“…- 37 On the other hand, the results of a recent study contrast with our data in showing comparaole effects of the /3-blocker atenolol and of enalapril on UAE in NIDDM patients. 39 However, the short duration of that study may explain the effects of atenolol on proteinuria.…”

contrasting

confidence: 99%

Captopril or conventional therapy in hypertensive type II diabetics. Three-year analysis.

et al. 1993

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The effects of long-term treatment with captopril and conventional therapy on albuminuria and metabolic parameters were compared in 74 hypertensive type II diabetics with normal serum creatinine. Patients were treated double-blind with either captopril monotherapy or combined with hydrochlorothiazide or therapy with metoprolol, hydrochlorothiazide, or both for 36 months. The treatment was titrated to achieve goal diastolic blood pressure of £85 mm Hg. The reductions in blood pressures during treatment were similar in patients with (n=21) and without (n=53) microalbuminuria treated with either captopril or conventional therapy. No significant changes in albuminuria occurred in normoalbuminuric patients with either therapy. Although albuminuria fell in nearly all patients with microalbuminuria treated with captopril, it rose in eight of 12 patients on conventional therapy, with macroalbuminuria developing in two of them. Renal function was preserved by both types of treatment in both patient groups. Long-term treatment with either conventional therapy or captopril did not alter metabolic variables. We conclude that captopril alone or in combination decreases albuminuria and prevents the development of macroalbuminuria in hypertensive type II diabetics with persistent microalbuminuria. The renoprotective effect of this agent, however, remains to be demonstrated with longer term data on renal function. Aggressive antihypertensive treatment with either captopril or conventional therapy appears to be effective in preventing the onset of microalbuminuria in most normoalbuminuric patients. In contrast, with previous short-term studies, the use of converting enzyme inhibitors or conventional therapy did not cause adverse metabolic effects. (Hypertension 1993^1:786-794) KEY WORDS • diabetes mellitus, non-insulin-dependent • captopril • antihypertensive agents • albuminuria R ecent cross-sectional studies have revealed a prevalence of microalbuminuria between 27% and 40% in patients with non-insulin-dependent diabetes mellitus (NIDDM) or type II diabetes attending diabetic clinics.

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confidence: 99%

Captopril or conventional therapy in hypertensive type II diabetics. Three-year analysis.

et al. 1993

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“…Some studies have shown beneficial effects similar to those seen with ACE inhibitors, 42,63,67 whereas others have shown either no benefit or adverse effects of CCBs compared with ACE inhibitors or ARBs. 76,77 Normoalbuminuria. The BENEDICT trial demonstrated that in subjects with type II diabetes and hypertension but with normoalbuminuria, the use of ACE inhibitor (trandolapril) alone or in combination with a CCB (verapamil) decreased the incidence of microalbuminuria to a similar extent.…”

Section: Years (Mean)mentioning

confidence: 99%

Evidence for renoprotection by blockade of the renin–angiotensin–aldosterone system in hypertension and diabetes

Karalliedde

Viberti

2006

J Hum Hypertens

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The incidence of end-stage renal disease (ESRD) is rising worldwide, accompanied by corresponding increases in the risk of morbidity and mortality. Underlying this trend are increasing rates of hypertension and diabetes mellitus, the two most common causes of ESRD. In addition to the adverse haemodynamic effects of hypertension on the kidney, elevated blood pressure (BP) can activate components of the renin-angiotensinaldosterone system (RAAS), which, in turn, activate mediators of inflammation, oxidative stress, cell growth, and matrix accumulation. Lowering BP reduces the risk of cardiovascular events and renal damage. Accumulating evidence from clinical and laboratory studies suggests that interrupting the RAAS with therapies such as angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and aldosterone receptor blockers can interfere with the mechanisms that promote diabetic and non-diabetic renal damage. Moreover, clinical trials of RAAS blockade have demonstrated reductions in microalbuminuria, a predictor of increased cardiorenal risk and overt nephropathy in patients with and without diabetes and/or hypertension. In this way, agents that block the RAAS should be considered the drugs of first choice as they provide enhanced renoprotection compared with other classes of antihypertensive agents such as calcium channel blockers and b-blockers.

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“…Similar results were observed in evaluating another eleven studies of patients with macroalbuminuric DN with a total of 177 patients (DMT1) and 76 patients (DMT2). [103][104][105][106][107][108][109][110][111][112][113] However, the ACCOMPLISH trial showed that the combination of amlodipine, a DHP CCB, with benazepril (ACEi), was superior to benazepril plus thiazide diuretic in reducing cardiovascular events 114 and the progression of kidney disease 115 in diabetes.…”

Section: Blood Pressure Controlmentioning

confidence: 99%

Therapeutic Modalities in Diabetic Nephropathy: Standard and Emerging Approaches

et al. 2011

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Diabetes mellitus is the leading cause of end stage renal disease and is responsible for more than 40% of all cases in the United States. Current therapy directed at delaying the progression of diabetic nephropathy includes intensive glycemic and optimal blood pressure control, proteinuria/albuminuria reduction, interruption of the renin-angiotensin-aldosterone system through the use of angiotensin converting enzyme inhibitors and angiotensin type-1 receptor blockers, along with dietary modification and cholesterol lowering agents. However, the renal protection provided by these therapeutic modalities is incomplete. More effective approaches are urgently needed. This review highlights the available standard therapeutic approaches to manage progressive diabetic nephropathy, including markers for early diagnosis of diabetic nephropathy. Furthermore, we will discuss emerging strategies such as PPAR-gamma agonists, Endothelin blockers, vitamin D activation and inflammation modulation. Finally, we will summarize the recommendations of these interventions for the primary care practitioner.

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Angiotensin converting enzyme inhibitors versus calcium antagonists in the treatment of diabetic hypertensive patients.

Cited by 61 publications

References 26 publications

Captopril or conventional therapy in hypertensive type II diabetics. Three-year analysis.

Captopril or conventional therapy in hypertensive type II diabetics. Three-year analysis.

Evidence for renoprotection by blockade of the renin–angiotensin–aldosterone system in hypertension and diabetes

Therapeutic Modalities in Diabetic Nephropathy: Standard and Emerging Approaches

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