Effects of ACE-inhibitors in hypertensive and normotensive diabetic patients with diabetic nephropathie.
Diabetic nephropathy leading to end stage renal failure with 30 to 40% cumulative incidence remains one of the great life threatening dangers for type I diabetics. Its natural history gets its impact due to the biochemical sequela of diabetic hyperglycemia such as polyol accumulation or glycation processes. Functional changes may be detected by microalbuminuria which in turn is followed by intraglomerular, intrarenal and finally systemic hypertension. Hypertension itself seems to be part of the self perpetuating process, and therefore antihypertensive treatment has been shown to be an effective area. Antihypertensive treatment by itself is effective in the slowing down of the decline of glomerular filtration rate, together with decreasing the amount of albumin excretion and, therefore, might be expected to be of value in prolonging the renal prognosis over a length of time. From the theoretical point of view the ACE inhibitors were looked upon as beneficial and therefore preferable as interventional tools because of their special effects of blood pressure redistribution within the glomeruli. Long term reports and a lot of short and intermediate term controlled studies were able to confirm the expected effects. Whether this is the case also in borderline hypertension or even in normotensive diabetics remains finally to be established. The question of long term effects such as survival rates and the superiority of antihypertensive treatments with beta blockers or drug combinations, or whether these results reflect merely their systemic blood pressure lowering effects remain finally to be elucidated.
Diabetes-Zentrum Quakenbrück, Fachabteilung für Diabetes und Stoffwechselkrankheiten am Christlichen Krankenhaus, Quakenbrück, Germany.
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Henrichs
D000419:Albuminuria / Q000503:physiopathology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003928:Diabetic Nephropathies / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007678:Kidney Glomerulus / Q000503:physiopathology
D000806:Angiotensin-Converting Enzyme Inhibitors