Captopril and atenolol are equally effective in retarding progression of diabetic nephropathy

Elving, L. D.; Wetzels, Jack F.M.; Lier, H. J. J. Van; Nobel, E. de; Berden, J.H.M.

doi:10.1007/s001250050154

Cited by 10 publications

(7 citation statements)

References 21 publications

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“…The renoprotective role of ACEI, beyond what can be attributed to BP reduction, has been shown in only 2 of 5 studies that compared these drugs to either CT or to CCB (25)(26)(27)(28)(29) in type 1 diabetic patients with overt nephropathy. In type 2 diabetic patients who also have overt nephropathy, 4 of 5 small trials that evaluated the effects of various classes of drugs failed to demonstrate that ACEI play any specific renoprotective role (20,30 -33).…”

Section: Renal Protectionmentioning

confidence: 99%

Optimizing Therapy in the Diabetic Patient with Renal Disease

Ravera¹,

Berruti²,

Leoncini³

et al. 2004

Journal of the American Society of Nephrology

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Abstract. Hypertension, impaired renal function, and proteinuria are commonly associated to the presence of diabetes. They play a major role in the development of cardiovascular and renal damage. Effective antihypertensive treatment reduces the progression of diabetic nephropathy and improves cardiovascular prognosis. Accordingly, tight BP control (Ͻ130/80 mmHg) is currently recommended in diabetic patients. Achieving BP targets represents the most important determinant of cardiovascular and renal protection. However, it has been suggested that specific classes of antihypertensive drugs may exert additional organ protection beyond their BP control. The pharmacologic blockade of the renin-angiotensin-aldosterone system has been shown to convey greater renal and cardiovascular protection compared with other classes of drugs. In particular, studies focusing on renal end point suggest that angiotensin-converting enzyme inhibitors (ACEI) are the firstchoice drugs in type 1 diabetes. Both ACEI and angiotensin II receptor blockers prevent the progression from microalbuminuria to clinical proteinuria in type 2 diabetes, but angiotensin blockers provide better renoprotection in patients with overt nephropathy. Regarding cardiovascular protection, several studies (but not all) have shown that ACEI exert a protective effect on diabetic patients. Recently, interesting results in favor of angiotensin receptor blockers have been reported in the IDNT, RENAAL, and LIFE studies. It should be noted that to achieve maximal renal and cardiovascular protection, most diabetic patients require integrated therapeutic intervention, including not only several antihypertensive drugs, but statins and antiplatelet therapy as well.Diabetes, hypertension, impaired renal function, and proteinuria are commonly associated conditions that act as a guilty company. They are, in fact, responsible for an increase in the risk of development and/or progression of cardiovascular disease, nephropathy, and retinopathy.Arterial BP plays a very important role in the development of renal damage and presents a complex relationship with diabetic nephropathy, with nephropathy raising BP, and with BP accelerating the course of nephropathy (1). Furthermore, as shown by epidemiologic studies, hypertension is responsible for increased cardiovascular morbidity and mortality associated with diabetes mellitus (1). Effective antihypertensive treatment reduces the risk of development and progression of nephropathy and, as is especially evident with angiotensinconverting enzyme (ACE) inhibitors (ACEI) and angiotensin receptor blockers (ARB), it lowers cardiovascular morbidity and mortality (2,3). Accordingly, current consensus groups have recommended tight BP control (Ͻ130/80 mmHg) in diabetic patients (2,4 -7).Proteinuria is considered a predictor of renal disease progression. Proteinuria acts on tubular cells by inducing inflammation and consequently interstitial fibrosis. In addition, proteinuria favors dyslipidemia, which aggravates renal damage and increases cardiov...

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Section: Renal Protectionmentioning

confidence: 99%

Optimizing Therapy in the Diabetic Patient with Renal Disease

Ravera¹,

Berruti²,

Leoncini³

et al. 2004

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…By contrast, in proteinuric patients with type 1 diabetes, a strict BP control was deemed effective in slowing the progression of nephropathy independently of the drug used (42); moreover, ACE-I appear to be clearly more renoprotective than other drugs, at least in two of five studies (RRR, approximately 30 to 60%) (43)(44)(45)(46)(47).…”

Section: Renal Protectionmentioning

confidence: 99%

Renal and Cardiovascular Protection in Type 2 Diabetes Mellitus

Deferrari

Ravera²,

Deferrari³

et al. 2002

Journal of the American Society of Nephrology

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Abstract. Aggressive treatment of hypertension is effective in reducing both microvascular and macrovascular complications in type 2 diabetes, and target BP less than 130/85 or 130/80 mmHg are now recommended. Inhibition of renin angiotensin aldosterone system (RAAS) plays an essential role in the treatment of hypertension and diabetes-related complications. Studies focusing on renal end-points suggest that angiotensinconverting enzyme inhibitors (ACE-I) are more effective than other traditional agents in reducing the onset of clinical proteinuria in both type 1 and type 2 diabetic patients with incipient nephropathy, mainly in normotensive ones (secondary prevention). However, several small trials in type 2 diabetic patients with overt nephropathy (tertiary prevention) failed to demonstrate a specific renoprotective role for ACE-I, at variance with type 1 diabetes. Three recent large trials address the question of whether angiotensin II receptor blockers (ARB) prevent the development of clinical proteinuria or delay the progression of nephropathy in type 2 diabetes. The IRMA study showed that irbesartan is more effective than conventional therapy in preventing the development of clinical proteinuria and in favoring the regression to normoalbuminuria for comparable BP control in patients with incipient nephropathy. The IDNT and RENAAL trials showed that ARB are more effective than traditional antihypertensive therapies in reducing progression toward end-stage renal failure (ESRF) in type 2 diabetic patients with overt nephropathy independently of changes in BP. Moreover, a reduction in hospitalizations for heart failure was demonstrated for ARB-treated patients compared with placebo. Furthermore, the LIFE study showed that losartan is more effective than conventional therapy in reducing cardiovascular morbidity and mortality in a cohort of diabetic patients with hypertension and left ventricular hypertrophy. In conclusion, ARB seem to be effective in both preventing renal damage and reducing progression toward ESRF in type 2 diabetic patients. Thus, the guidelines for the prevention and treatment of diabetic nephropathy are now changed. In type 1 diabetes ACE-I are the first-choice drug; in type 2 diabetes, ARB are considered first-choice drugs in secondary prevention as well as ACE-I and have been now elected the unique first-choice drug in tertiary prevention of ESRF. Finally, ARB should be considered as the first-choice drug in cardiovascular prevention too, as well as ACE-I.Hypertension is an extremely common comorbid condition in type 2 diabetes. Its prevalence is higher than in the general population, thus contributing to explain the increased risk of both microvascular and macrovascular complications observed in diabetic patients. Hypertension appears to play an important role in the development and progression of renal damage in type 2 diabetes (1,2). Furthermore, hypertension is a major risk factor for the increased cardiovascular morbidity and mortality associated with diabetes mellitus, as confirmed b...

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“…118 Our observation of a low rate of decline in GFR of 4.4 m min Ϫ1 year Ϫ1 during ACE inhibition is in accordance with most studies of more than 18 months duration using either ACE inhibition or conventional antihypertensive treatment. 7,57,63,127,128 Are calcium channel blockers as good as ACE inhibitors in preserving kidney function in patients with diabetic nephropathy? In general the studies with calcium antagonists in diabetes have suffered from being either short, uncontrolled, mixing Type 2 DM and Type 1 DM, including normo-, micro-and macroalbuminuric patients, or including few patients.…”

mentioning

confidence: 99%

Promotion, prediction and prevention of progression of nephropathy in Type 1 diabetes mellitus

Rossing

1998

Diabet. Med.

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The scope of the present review is to discuss the prognosis of diabetic renal disease, putative progression promoters and the possibilities for treatment and prediction of treatment efficacy. The recent changes in the incidence of diabetic nephropathy in Type 1 diabetes mellitus are discussed. Promoters of progression in diabetic nephropathy are evaluated, in particular arterial blood pressure, glycaemic control, albuminuria and cholesterol levels. Potential treatment modalities are discussed, with special focus on antihypertensive therapy, including a discussion of a specific renoprotective action of certain antihypertensive agents. Furthermore putative predictors of treatment efficacy are evaluated, demonstrating that the ability to lower the urinary albumin excretion rate after onset of treatment heralds a slow progression of the renal disease. The prognosis in diabetic renal disease has improved with an increase in median survival after onset of nephropathy from 6 to 15 years. This has exposed the importance of cardiovascular morbidity and mortality. The identification and treatment of cardiovascular risk factors has become essential. Although the prognosis has improved remarkably, the primary goal should be prevention of diabetic nephropathy, as it is unlikely that the increased risks associated with this complication can be eliminated.

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Captopril and atenolol are equally effective in retarding progression of diabetic nephropathy

Cited by 10 publications

References 21 publications

Optimizing Therapy in the Diabetic Patient with Renal Disease

Optimizing Therapy in the Diabetic Patient with Renal Disease

Renal and Cardiovascular Protection in Type 2 Diabetes Mellitus

Promotion, prediction and prevention of progression of nephropathy in Type 1 diabetes mellitus

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