INHIBITORS AND BLOCKERS OF RENIN-ANGIOTENSIN SYSTEM IN THE PREVENTION AND IN DELAYING THE PROGRESSION OF DIABETIC NEPHROPATHY – A COMPARATIVESTUDY (original) (raw)
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International Journal of Advanced Biomedical and Pharmceutical Research, 2012
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
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.
Angiotensin-Converting Enzyme (ACE) Inhibition Therapeutic Option for Diabetic Hypertensive Patients
Drugs, 1990
Angiotensin-converting enzyme (ACE) insertion(I)/deletion (D) polymorphism may modify the effect of inhibition of the renin-angiotensin-aldosterone system (RAAS) on survival and cardiorenal outcomes in type 2, diabetes. A consecutive cohort of 2089 Chinese type 2 diabetic patients with mean (7standard deviation) age of 59.7713.1 years were genotyped for this polymorphism by polymerase chain reaction method and were followed prospectively for a median period of 44.6 (interquartile range: 23.7, 57.5) months. Clinical outcomes, including all-cause mortality, cardiovascular and renal end points, were examined. The frequency for I allele was 67.1 and 32.9% for D allele, with observed genotype frequencies of 45.8, 42.6, and 11.6% for 3, DI and DD, respectively. ACE DD polymorphism was an independent predictor for renal end point with hazard ratio (HR) (95% confidence interval) of 1.72 (1.16, 2.56), but not for cardiovascular end point or mortality. After controlling for confounding factors, including ACE I/D genotype, the usage of RAAS inhibitors was associated with reduced risk of mortality (HR 0.34 (0.23, 0.50)) and renal end point (HR 0.55 (0.40, 0.75)). On subgroup analysis, the beneficial effects on survival (II vs DI vs DD: HR 0.29 (0.16, 0.51) vs 0.25 (0.14, 0.46) vs 1. 33 (0.41, 4.31)) and renoprotection (II vs DI vs DD: 0.52 (0.30, 0.90) vs 0.43 (0.25, 0.72) vs 0.95 (0.43, 2.12)) were most evident in II and DI carriers. In conclusion, inhibition of RAAS was associated with reduced risk of mortality and occurrence of renal end point in Chinese type 2 diabetic patients. These benefits were most evident among II and DI carriers.
Renin-Angiotensin-Aldosterone System Inhibition and Improvement in Glucose Tolerance
The Journal of Clinical Hypertension, 2009
A linchpin of the cardiometabolic syndrome is insulin resistance, an important cardiovascular and chronic kidney disease risk factor. Activation of the renin-angiotensin-aldosterone system (RAAS) has been shown to impair insulin metabolic signaling and insulin-stimulated glucose uptake as well as pancreatic secretion of insulin. Recent work has highlighted the role of aldosterone as an important component of the RAAS and may play a role in not only altering glucose uptake in skeletal muscle but in normal liver metabolism as well. Like angiotensin II, aldosterone may promote hepatosteatosis and impact pancreatic b-cells. By blocking the effects of angiotensin II with a RAAS blocker or aldosterone with a mineralocorticoid inhibitor, the effects may be reversed. Therefore, it appears that the RAAS and aldosterone are important in generation of reactive oxygen species in the b-cell and increased apoptosis. It is clear that preclinical evidence has demonstrated a role for the RAAS and glucose metabolism. While there is sufficient clinical data to support RAAS inhibition with either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker, it is important to note none of these studies were powered to address glucose tolerance as a primary end point. Thereby, to complement preclinical studies, more randomized multicenter outcomes evidence is needed to fully elucidate the impact that RAAS inhibition and, specifically, the use of angiotensin receptor blockers have on glucose tolerance. Nonetheless, the weight of evidence suggests that inhibition of the RAAS vs other antihypertensive agents, whether calcium channel blockers, thiazide diuretics, or b-blockade, improve glucose tolerance. J Clin Hypertens (Greenwich). 2009;11:S40-S47. ª 2009 Wiley Periodicals, Inc. T here are approximately 30 million people with diabetes mellitus in the United States, with an estimated 8 to 9 million individuals with undiagnosed type 2 diabetes. However, the burgeoning increase in the prevalence of diabetes is just the tip of the iceberg. A precursor of this disorder, the cardiometabolic syndrome (CMS), is much more prevalent and growing rapidly in the United States. It is estimated that approximately 49 million Americans have CMS according to the Third Report of the Adult Treatment Panel National Cholesterol Education Program (NCEP-ATP III) III criteria. 1 Indeed, many of the 70 million persons with hypertension (HTN) have CMS. 1,2 Largely because of the increasing number of overweight and obese persons, the prevalence of the CMS is growing rapidly, not only in
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 indi...
Renin-Angiotensin-Aldosterone System Antagonists and the Prevention of Type 2 Diabetes Mellitus
Current Pharmaceutical Design, 2012
ACE inhibitors have established their role in the management of hypertension as well as in the primary and secondary prevention of cardiovascular events. Furthermore, they have proven their role in delaying the worsening of renal function in patients with chronic renal disease. Over the last few years their use to prevent the new onset of diabetes has come to the forefront. Post-hoc analyses of large mutli-center clinical trials such as the Captopril Prevention Project and the Heart Outcomes Prevention Evaluation have suggested that their use may delay or prevent the onset of diabetes. However many of these results are based on secondary analyses and few prospective clinical trials exist. In the two prospective trial so far conducted regarding the use of ACEi and ARB as a means to diabetes prevention the effects of these drugs compared to lifestyle modifications have been minimal and do not yet warrant their use to this effect. While there is strong evidence for modulation the Renin-Angiotensin System in patients with hypertension, coronary heart disease and renal dysfunction the evidence for preventing diabetes remains scarce and will need to be investigated further.
Short- and long-term glycaemic control and the state of the renin system in type 1 diabetes mellitus
Journal of the renin-angiotensin-aldosterone system : JRAAS, 2007
Renin system blockade in diabetes exerts a strong positive influence on complications, especially nephropathy. In hyperglycaemic diabetic subjects, however, blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors results in a marked rise in plasma renin.We investigated whether glycaemic fluctuations measured in hours, or those measured in weeks by Haemoglobin A1C (HbA1C) , influenced the plasma renin response to captopril. Fifty-four type 1 diabetic subjects were studied in high-salt balance. After an all night fast and in the supine position, baseline serum glucose level was drawn. Iv. glucose and insulin were then administered to keep serum glucose between 100 and 150 mg/dL (target). When target was reached, captopril 25 mg pre os was administered and plasma renin activity (PRA) and finger stick glucose were drawn, then serially every 45 minutes for 225 minutes. Baseline glucose and baseline PRA were drawn hours apart. Peak PRA corresponded to the re...
Blockade of the renin-angiotensin system for the primary prevention of diabetic
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.