Volume 2, Number 3, September 2001

Renoprotection in Type 2 diabetes: blockade of the renin-angiotensin system with angiotensin II receptor blockers
Pauline A Swift, Graham A MacGregor

Diabetic nephropathy is now the leading cause of end-stage renal disease (ESRD) in developed countries. The worldwide prevalence of Type 2 diabetes is rapidly increasing, and so the incidence of diabetic renal disease will continue to rise. The majority of Type 2 diabetics, however, will die from cardiovascular disease rather than renal disease.
Treatment strategies in diabetics aim to slow the onset and progression of renal disease and other microvascular complications and to reduce the associated excess cardiovascular risk. Blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors (ACE-I) has been shown to improve both renal and cardiovascular outcome in patients with Type 1 diabetes. The relative importance of blood pressure reduction as opposed to the unique benefits of any particular therapeutic agent, in Type 2 diabetics, has been less clearly defined. Recently, however, three prospective clinical trials, Irbesartan on Microalbuminuria in hypertensive patients with Type 2 diabetes Study (IRMA 2), Irbesartan Type 2 Diabetic Nephropathy Trial (IDNT) and Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL), have evaluated the effect of angiotensin II (Ang II) receptor blockers (ARBs) on cardiovascular and renal outcomes, in Type 2 diabetics. The results of these trials have been published simultaneously in the New England Journal of Medicine.
The studies collectively demonstrate that Ang II receptor blockade slows the progression of Type 2 diabetic renal disease, and as such they represent an important step forward in the management of Type 2 diabetes. It is not clear how they might compare with ACE-I for this indication.

JRAAS 2001;2:170-173.

View full PDF article (open in new window)
Email this article

Right click on this DOI link and copy link to cite this article (What is a DOI link?)