| Title: |
Renal and cardiovascular protection in type 2 diabetes mellitus: Angiotensin II receptor blockers |
| Authors: |
Deferrari G.; Ravera M.; Deferrari L.; Vettoretti S.; Ratto E.; Parodi D. |
| Contributors: |
Deferrari, G; Ravera, M; Deferrari, L; Vettoretti, S; Ratto, E; Parodi, D |
| Publisher Information: |
Lippincott Williams and Wilkins; US |
| Publication Year: |
2002 |
| Collection: |
Università degli Studi di Milano-Bicocca: BOA (Bicocca Open Archive) |
| Subject Terms: |
albumin; aldosterone; amlodipine; angiotensin; antihypertensive agent; creatinine; dipeptidyl carboxypeptidase inhibitor; diuretic agent; irbesartan; placebo; renin |
| Description: |
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 angiotensin-converting 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 ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
STAMPA |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/12466318; info:eu-repo/semantics/altIdentifier/wos/WOS:000178904900013; volume:13; issue:3; firstpage:224; lastpage:229; numberofpages:6; journal:JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY; https://hdl.handle.net/10281/547884 |
| DOI: |
10.1097/01.asn.0000032544.37147.ae |
| Availability: |
https://hdl.handle.net/10281/547884; https://doi.org/10.1097/01.asn.0000032544.37147.ae |
| Accession Number: |
edsbas.B1E7829C |
| Database: |
BASE |