Short term effect of captopril on microalbuminuria induced by exercise in normotensive diabetics.

Romanelli, Giuseppe; Giustina, Andrea; Cimino, Antonino; Valentini, U; Agabiti‐Rosei, Enrico; Muiesan, G; Giustina, G.

doi:10.1136/bmj.298.6669.284

Cited by 42 publications

(25 citation statements)

References 19 publications

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“…A negative exercise test may have particular value in identifying patients who will not develop microalbuminuria, given the high specificity of the negative result in our study. It remains to be established whether or not the treatment of patients with increased exercise U A /U C with either antihypertensive (15) or improved glycemic control (6,16) can prevent the development of microalbuminuria and whether or not the results of the present study also apply to noninsulin-dependent diabetic subjects.…”

mentioning

confidence: 78%

Exercise Testing as a Long-Term Predictor of the Development of Microalbuminuria in Normoalbuminuric IDDM Patients

O’Brien

Watts²,

Powrie³

et al. 1995

Diabetes Care

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mentioning

confidence: 78%

Exercise Testing as a Long-Term Predictor of the Development of Microalbuminuria in Normoalbuminuric IDDM Patients

O’Brien

Watts²,

Powrie³

et al. 1995

Diabetes Care

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“…Arterial grafts, which in our study showed preserved functional and structural integrity, appeared, therefore, to be more suitable for CABG procedure, particularly in the presence of poorly compensated diabetes or when signs of peripheral diabetes-related complications have already occurred. More aggressive or patient-tailored pharmacological therapy could be also advisable in diabetic subjects (32)(33)(34)(35)(36), especially those with poorly controlled disease, in an attempt to reduce the impact of other risk factors on the fate of venous conduits, although this approach has given conflicting results.…”

Section: Discussionmentioning

confidence: 99%

Influence of Type 2 Diabetes on Functional and Structural Properties of Coronary Artery Bypass Conduits

et al. 2003

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Recent studies have reported a high incidence of postoperative unfavorable cardiac-related events in patients with diabetes who underwent coronary artery bypass grafting (CABG). Structural and functional characteristics of CABG conduits, which have been shown to play an important role in patient outcome after myocardial revascularization, have not been fully investigated in diabetic subjects. Therefore, we sought to determine the influence of adult-onset diabetes on vasoreactivity and morphological profile of venous and arterial grafts. Of the 160 consecutive patients enrolled in the study, 90 were diagnosed with type 2 diabetes and 70 did not have diabetes (control group). All patients underwent evaluation of glucose control before surgery. Tissue specimens were collected from left internal thoracic artery (LITA) and saphenous vein (SV) grafts harvested during elective CABG. Functional tests were performed to assess contractile and vasodilative responses of bypass conduits. Histological evaluation was carried out to examine vessel wall structure. Univariate and multivariate analyses were performed to correlate the preoperative factors related to the control of the endocrine disorder with histological findings. Patient medical history and demographics did not differ between the groups. Diabetic patients showed significant microalbuminuria and higher plasma levels of C-peptide and GHb as compared with nondiabetic subjects. Functional tests of the LITA segments revealed no difference between groups with regard to contractile and vasodilative responses. In contrast, significant impairment in the endothelium-related vasodilation of the SV grafts was observed in diabetic subjects. Histological studies showed structural preservation of the arterial conduits in both groups. However, marked intimal abnormalities (also atherosclerotic calcified plaques) were detected in SV grafts harvested from diabetic patients. Logistic regression analysis showed that high levels of proteinuria and GHb were independent predictors of advanced structural degeneration of SV conduits. Treatment modality, duration of diabetes, and other demographic or metabolic factors were found to have no influence on the morphological characteristics of SV conduits. In conclusion, biological properties of LITA conduits for CABG were preserved in diabetic patients. However, these patients frequently showed impairment of the endothelium-dependent vasorelaxation and intimal degeneration of SV grafts. The extent of structural abnormalities of SV grafts was inversely correlated with the efficacy of the metabolic control of the endocrine disorder. Further studies are required to conclusively correlate preoperative SV graft abnormalities with postoperative conduit patency rate and the occurrence of adverse cardiac-related events in diabetic subjects.

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“…These and previous results suggest that microalbuminuria is largely dependent on pressure, probably because of glomerular hypertension (55,58,59). Studies in normotensive insulin-treated rats with streptozocin-induced diabetes have shown that inhibition of ACE reduces the abnormally elevated glomerular hydraulic pressure and confers definite longterm protection against development of glomerulopathy (60,61).…”

Section: Impact Of Antihypertensive Treatment On Kidney Function In Imentioning

confidence: 82%

Impact of Blood Pressure and Antihypertensive Treatment on Incipient and Overt Nephropathy, Retinopathy, and Endothelial Permeability in Diabetes Mellitus

Parving

1991

Diabetes Care

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Diabetic nephropathy is the main cause of the increased morbidity and mortality in insulin-dependent diabetes mellitus (IDDM) patients. Elevated blood pressure accelerates and effective blood pressure reduction with beta-blockers and/or angiotensin-converting enzyme (ACE) inhibitors delays the progression of nephropathy and reduces albuminuria. All previous reports dealing with the natural history of diabetic nephropathy demonstrated a cumulative death rate between 50 and 77% 10 yr after onset of nephropathy. Effective antihypertensive treatment reduced the cumulative death rate to 15-20% 10 yr after onset of nephropathy. Recent randomized control studies indicate that ACE inhibition may delay and even prevent the development of diabetic nephropathy in normotensive IDDM patients with persistent microalbuminuria. Several cross-sectional and prospective studies suggest an association between elevated blood pressure and the development and progression of diabetic retinopathy. Furthermore, carotid insufficiency or other causes of unilaterally or bilaterally reduced retinal blood flow (pressure) diminish the development of diabetic retinopathy. Diabetic retinopathy is characterized by abnormal leakage of fluorescein through the blood-retinal barrier, an abnormality that can be reversed during antihypertensive treatment. It is well documented that elevated blood pressure, poor metabolic control, and diabetic microangiopathy independently enhance the endothelial leakage of plasma proteins in diabetes mellitus. A link between capillary hypertension, increased extravasation of plasma proteins, and the development and progression of diabetic microangiopathy has been suggested. Blood pressure reduction diminishes the extravasation of plasma proteins. The above results strongly support the case for early and effective treatment of arterial blood pressure elevation in diabetes.

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Short term effect of captopril on microalbuminuria induced by exercise in normotensive diabetics.

Cited by 42 publications

References 19 publications

Exercise Testing as a Long-Term Predictor of the Development of Microalbuminuria in Normoalbuminuric IDDM Patients

Exercise Testing as a Long-Term Predictor of the Development of Microalbuminuria in Normoalbuminuric IDDM Patients

Influence of Type 2 Diabetes on Functional and Structural Properties of Coronary Artery Bypass Conduits

Impact of Blood Pressure and Antihypertensive Treatment on Incipient and Overt Nephropathy, Retinopathy, and Endothelial Permeability in Diabetes Mellitus

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