Volume 2, Number 1, March 2001

The renin-angiotensin-aldosterone system, blockade and diabetic nephropathy
Norman K Hollenberg

What is the place of angiotensin receptor blockers in the prevention of diabetic nephropathy? Only a large, rigorous, randomised, double-blind assessment of a therapeutic candidate compared with the appropriate alternative can prove therapeutic efficacy. One such trial assessed the effect of the angiotensin-converting enzyme (ACE) inhibitor, captopril, in patients with insulin-dependent diabetes mellitus (IDDM) who were at risk of nephropathy,¹ with results that were sufficiently impressive that the use of captopril quickly became a professional necessity supported by public policy. Moreover, multiple lines of evidence accumulated over a decade suggested that this useful feature of captopril was a class action, extending to all ACE inhibitors (ACE-I).^2,3 In the case of the angiotensin II (Ang II) AT₁-receptor antagonists (AT₁ antagonists), we are fortunate in having, very early in the development of these agents, two ongoing, major, high quality trials in patients with NIDDM who are at risk of nephropathy – one involving irbesartan, the other involving losartan.

JRAAS 2001;2:185-187.

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