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Abstract

Angiotensin 2 plays a key role in the pathogenesis of hypertension and CV and renal disease. Randomized controlled trials shown that ACE inhibitors provide cardiovascular and microvascular benefits and may also improve insulin resistance and prevent the development of diabetes. Furthermore, ACE inhibitors provide considerable benefits in diabetic patients with heart failure, and reduced left ventricular mass and left ventricular dilation and significantly reduced mortality and hospitalization for heart failure. Thus, ACE inhibitors are currently recommended as a first line treatment for patients with hypertension and diabetes particularly those with proteinuria as well as those with heart failure. Data from randomized controlled trials in patients with type 2 diabetes suggest that ARBs may be considered equal to ACE inhibitor for renal protection. For example, the Reduction of Endpoints in NIDDM with the Angiotensin Losartan (REENAL) trial demonstrated that angiotensin II receptor blocker combined with conventional antihypertensive treatment as needed confers significant renal protection in patients with type 2 diabetes and nephropathy. The risk of the primary end point (a composite of doubling of serum creatinine, end stage renal disease or death from any cause) was reduced by 16% with losartan. The risk of doubling of serum creatinine was reduced by 25% and the risk of end stage renal disease was reduced by 28% over a follow up period of 3.4 years. The study also documented reduction in the initial hospitalization for heart failure. These benefits were above and beyond those attributable to BP reduction alone, suggesting that ARBs, like ACE inhibitors, have special beneficial cardiovascular/renal benefits in diabetic patients.

Angiotensin Therapy, Diabetes Mellitus
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© American Journal of Hypertension, Ltd. 2002
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