Angiotensin receptor blockers in diabetic nephropathy: renal and cardiovascular end points (original) (raw)
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International Journal of Pharmacy and Pharmaceutical Sciences, 2016
Objective: To observe the clinical outcomes on usage of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in type 2 diabetic nephropathy patients. Methods: A total 70 patients diagnosed with diabetic nephropathy were treated with ACEIs or ARBs were enrolled in this study. The data was collected from the out patients and the physician. A data collection form was used for collecting patient data. The form was used to record the details of patient's demographics, history of diabetes mellitus, duration of diabetes mellitus co morbidities, food habits and laboratory parameters such as serum creatinine, HbA1c and all the relevant things. The study has obtained ethical clearance from the institution ethics committee (IEC). Results: The study showed middle aged patients were more prone to diabetes and pre-existing hypertension is a major risk factor for diabetic nephropathy. Majority of the patients had long duration of diabetes mellitus which indicates the strong relation between duration of diabetes mellitus with diabetic nephropathy. Compared to ACE inhibitors, ARBs decreased the level of renal parameters. This reveals the better renoprotective effect of ARBs over ACE inhibitors. ARBs had more beneficial effects in reducing the major risk factor like proteinuria in diabetic nephropathy. A considerable reduction in HbA1c values were also observed in patients using ARBs. Conclusion: While comparing the improvement in proteinuria and the laboratory outcomes, ARBs were beneficial relatively to the ACEs in patients with diabetic nephropathy.
Blood Pressure, Hypertension, RAAS Blockade, and Drug Therapy in Diabetic Kidney Disease
Advances in Chronic Kidney Disease, 2014
Type 2 diabetes is the most common cause of CKD and ESRD in the United States and the Western world. Hypertension is prevalent in this cohort, and control of blood pressure is perhaps the most important risk factor to reduce CKD progression. The most recent evidence of blood pressure targets recommended by the Kidney Disease: Improving Global Outcomes and Kidney Disease Outcomes Quality Initiative guideline committees is less than 140/90 mmHg for all patients with CKD Q3 . There is some evidence, for those with 1 g or more of albuminuria, albeit weak, to support a blood pressure target of less than 130/80 mmHg. Multiple studies demonstrate that renin-angiotensin-aldosterone system (RAAS) blockers are important in reducing cardiovascular risk and progression of CKD in those with advanced proteinuric nephropathy. However, there is no evidence that they prevent nephropathy or that reduction in microalbuminuria alone is associated with a slowed nephropathy progression. The purpose of this article is to review the major studies that have evaluated cardiovascular and kidney endpoints in patients with diabetes and the role of RAAS blockers in the treatment of this disease.
Blockade of the renin–angiotensin system for the primary prevention of diabetic nephropathy
Diabetes management, 2012
The prevention of chronic kidney disease is a primary goal for diabetes management. Lowering blood pressure can reduce the incidence of microalbuminuria in Type 1 or Type 2 diabetes, especially in patients with hypertension. Blockade of the renin-angiotensin system (RAS) is an effective strategy to reduce blood pressure in diabetic patients, but no more so than other antihypertensive strategies. RAS blockers have a more favorable side-effects profile compared to other antihypertensive agents, meaning that generally patients are more likely to take them. Any 'independent' effect of RAS blockade for the primary prevention of diabetic nephropathy, beyond blood-pressure control, remains to be clearly established. New combination strategies using renin inhibitors or aldosterone antagonists, to achieve a more complete RAS blockade, have the potential to improve renal outcomes in patients with diabetes. Summary There is clear evidence for the pathogenic role of the renin-angiotensin system (RAS) in the progression of diabetic kidney. Treatment with either an a ngiotensin-converting enzyme inhibitor or angiotensin receptor blocker have been shown to reduce proteinuria and preserve renal function in patients with diabetes and chronic kidney disease. While such data provide a strong rationale for early and sustained blockade of the RAS for the primary prevention of kidney disease, clinical trial evidence to support this goal is limited and inconsistent. By contrast, data from observational and clinical trials clearly demonstrate the primacy of blood-pressure control in the development of diabetic kidney disease, especially in hypertensive patients. Whether RAS blockade offers additional benefits for primary prevention, over-and-above blood-pressure control, remains contentious. At best, any 'independent effects' on primary prevention are modest, and certainly not the panacea envisaged by many practitioners. However, the better tolerability, efficacy and side-effects profile of RAS blockers, and other actions on retinopathy and cardiovascular disease, means that most patients with diabetes currently receive RAS blockers as first line antihypertensive agents. The future development of more effective 'escape-proof' regimens currently offers the best way forward to realize the hope that RAS blockade will ultimately prevent diabetic kidney disease in the clinic as effectively as it does in animal models.
International Journal of Pharmacy Practice & Drug Research
To evaluate the effect of Angiotensin Converting Enzyme Inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) in glycemic control among the Diabetic Nephropathy patients. A cross sectional study was done among the type 2 diabetics presenting consecutively to a diabetes specialty hospital with Diabetic Nephropathy. 35 patients were studied over a period of five months Patients were subjected to the clinical and laboratory investigations. The patient had average age of 57.1 years and the average duration of diabetes mellitus was 9.35 years and patients are grouped into two as ACEI and ARB. Both the groups are also treated for glycemic control with Gliclazide-Metformin combination (48.57%) and Glimepride-Metformin combination (28.57%) & others (22.86%). We found that at initial visit, average Blood Glucose (F) was 132mg/dl & 134mg/dl and Average Blood Glucose (PP) was 211mg/dl & 226mg/dl in ACEI & ARB groups respectively. The Initial average HbA1c values are 8.33 % & 8.71 % in ACEI & ARB groups respectively. On subsequent visits it is found to be reduced to 127mg/dl & 115mg/dl of Blood Glucose (F) and 208mg/dl & 189mg/dl of Blood Glucose (PP) in both groups respectively and HbA1c is also found to be reduced to 8.17 and 7.08 in both groups respectively. Thus we conclude that among the two groups ARB group has significant effect on glycemic control compared to ACEI group.
Dual blockade of the renin-angiotensin system in type 1 patients with diabetic nephropathy
Nephrology Dialysis Transplantation, 2002
Background. Albuminuria and hypertension are predictors of poor renal and cardiovascular outcome in patients with diabetes. Approximately 30% of type 1 patients with diabetic nephropathy (DN) have albuminuria )1 guday, and blood pressure )135 anduor )85 mmHg despite antihypertensive therapy with recommended doses of ACE inhibitor (ACEI) and diuretics. We tested the effect of dual blockade of the renin-angiotensin system (RAS) in these patients. Methods. We performed a randomised double blind crossover trial with 2 months treatment with Irbesartan 300 mg o.d. and placebo added on top of previous antihypertensive treatment. We included 21 type 1 patients with DN responding insufficiently to ACEI and diuretics, as defined above. At the end of each treatment period, albuminuria, 24-h blood pressure and glomerular filtration rate (GFR) were measured. Results. Addition of 300 mg Irbesartan to the patients' usual antihypertensive therapy induced a mean reduction in albuminuria of 37% (95% CI 20-49, P-0.001); from 1574 mgu24 h (95% CI 1162-2132) to 996 mgu24 h (95% CI 699-1419), a reduction in 24-h blood pressure of 8 mmHg systolic (95% CI À2 to 18) and 5 mmHg diastolic (95% CI 1-9) (Ps0.11 and 0.01, respectively) (from placebo, mean (SE) 146 (4)u80 (2) mmHg). GFR remained unchanged. Serum potassium increased (mean 4.3 to 4.6 mmolul, Ps0.02). Intervention to reduce serum potassium was needed in two patients with GFR -35 mluminu1.73 m 2 . Otherwise the dual blockade with Irbesartan was safe and well tolerated. Conclusions. Dual blockade of the RAS may offer additional renal and cardiovascular protection in type 1 patients with DN responding insufficiently to conventional antihypertensive therapy, including recommended doses of ACEI and diuretics.
Renal and Cardiovascular Protection in Type 2 Diabetes Mellitus: Angiotensin II Receptor Blockers
Journal of the American Society of Nephrology, 2002
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 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 developm...
Hong Kong Journal of Nephrology, 2007
Background: The present study was undertaken to determine whether combination therapy of angiotensin converting enzyme inhibitor (ACEI) and angiotensin AT1 receptor antagonist (ARA) is a useful tool for reducing albuminuria in diabetic nephropathy. Methods: Thirty-four subjects with diabetic nephropathy were enrolled in the present study. All the subjects had hypertension and urinary albumin index (UAI) < 1,000 mg/g creatinine. They were divided into three groups. Group 1 of 16 subjects was initially treated with imidapril (5-10 mg). Group 2 of eight subjects had losartan (50-100 mg) added to consecutive therapy with imidapril. Group 3 of 10 subjects had imidapril (5-10 mg) added to consecutive therapy with losartan. Blood pressure and UAI were determined before and 3 and 6 months after the start of the present study. Results: Blood pressure was significantly decreased in Group 1 subjects. Blood pressure was also reduced in Groups 2 and 3, but its reduction was not significant. Imidapril significantly reduced UAI in Group 1, from 213.1 ± 46.6 to 111.6 ± 35.6 (p < 0.001) and 114.5 ± 35.4 mg/g creatinine (p < 0.01) 3 and 6 months after imidapril treatment, respectively. The addition of losartan further reduced UAI in Group 2, who had been treated with imidapril. UAI decreased from 328.8 ± 87.3 to 185.3 ± 51.4 (p < 0.05) and 244.8 ± 88.3 mg/g creatinine 3 and 6 months after the addition of losartan, respectively. In contrast, the addition of imidapril to losartan therapy did not alter UAI in Group 3. Conclusion: These results indicate that the addition of ARA to consecutive therapy with ACEI augments a protective effect against the progression of diabetic nephropathy.